Richtlijn 'Melanoom' (3e herziening)

J.J.E. van Everdingen, H.J. van der Rhee, C.C.E. Koning, O.E. Nieweg, W.H.J. Kruit, J.W.W. Coebergh en D.J. Ruiter

Guidelines 'Melanoma' (3rd revision)

– The guidelines ‘Melanoma’ (3rd revision) are evidence-based in nature. A number of outcomes are summarised in this article.

– Dermatoscopy deserves a standard role in the clinical diagnosis of pigmented skin abnormalities.

– Pathological findings from a diagnostic excision should be recorded meticulously to include anatomical localisation, type of intervention used, excision margin, diagnosis, Breslow thickness, and the completeness of the removal.

– The sentinel node procedure should be reserved for patients who want to be as informed as possible about their prognosis. The procedure is not considered a part of standard diagnosis.

– Sentinel node assessment should include stains for specific markers and should be conducted in multiple sections.

– The following margins of non-affected skin are recommended for therapeutic re-excision of melanoma: in situ melanoma, 0.5 cm; Breslow thickness B 2 mm, 1 cm; Breslow thickness > 2 mm, 2 cm.

– Pathological assessment of a re-excised specimen depends on the completeness of the first excision.

– Systematic adjuvant treatment of patients with melanoma is not recommended outside the context of a clinical study.

– Patients with metastatic melanoma are preferably treated within a clinical study. Outside of a clinical study, these patients should be treated with dacarbazine.

– There is no evidence to suggest that survival is improved by frequent follow-up. However, follow-up can be a useful way to meet the information needs of patients and care requirements for physicians.

Ned Tijdschr Geneeskd 2005;149:1839-43