title: Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2016.
abstract: Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organisation of Research and Treatment of Cancer was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically using dermoscopy and staging is based upon the AJCC system. CMs are excised with 1-2 cm safety margins. Sentinel lymph node dissection is routinely offered as a staging procedure in patients with tumours >1 mm in thickness, although there is as yet no clear survival benefit for this approach. Interferon-α treatment may be offered to patients with stage II and III melanoma as an adjuvant therapy, as this treatment increases at least the disease-free survival and less clear the overall survival (OS) time. The treatment is however associated with significant toxicity. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic treatment is indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies should be considered. BRAF inhibitors like dabrafenib and vemurafenib in combination with the MEK inhibitors trametinib and cobimetinib for BRAF mutated patients should be offered as first or second line treatment. Therapeutic decisions in stage IV patients should be primarily made by an interdisciplinary oncology team ('Tumour Board').
authors.affiliation: Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany. Electronic address: claus.garbe@med.uni-tuebingen.de.
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
authors.affiliation: Institute of Dermatology, Catholic University, Rome, Italy.
authors.forename: Ketty
authors.initials: K
authors.lastname: Peris
authors.affiliation: Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Hauschild
authors.affiliation: University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Saiag
authors.affiliation: NIHR Biomedical Research Centre, University of Oxford, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Middleton
authors.affiliation: Department of Oncology, Odense University Hospital, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Bastholt
authors.affiliation: University Department of Dermatology, Marseille, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Grob
authors.affiliation: Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Malvehy
authors.affiliation: Section of Biostatistics and Epidemiology, Leeds Institute of Cancer and Pathology, University of Leeds, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Newton-Bishop
authors.affiliation: 1(st) Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Stratigos
authors.affiliation: University Department of Dermatology, Vienna, Austria.
authors.forename: Hubert
authors.initials: H
authors.lastname: Pehamberger
authors.affiliation: Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Eggermont
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D059447:Cell Cycle Checkpoints; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods; D032921:Consensus; D046169:Dermoscopy / Q000379:methods; D005060:Europe; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008545:Melanoma / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D025202:Molecular Diagnostic Techniques; D058990:Molecular Targeted Therapy / Q000379:methods; D009367:Neoplasm Staging / Q000379:methods; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012878:Skin Neoplasms / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents
keywords: Adjuvant treatment; Cutaneous melanoma; Excisional margins; Interferon-α; Metastasectomy; Sentinel lymph node dissection; Systemic treatment; Tumour thickness