– 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