Though still considered controversial, several evolving treatment and management plans for primary cutaneous melanoma are making their way into the mainstream and challenging more traditional approaches.
“The standard of care for primary cutaneous melanoma may slowly be changing in light of the recent advancements and positive outcomes we are seeing with Mohs surgery, slow Mohs and new genetic molecular tests for diagnosis and prognosis of the tumor,” says M. Laurin Council, M.D., FAAD, FACMS, associate professor of dermatology, John T. Milliken department of internal medicine, Washington University School of Medicine, St. Louis.
Mohs surgery is generally accepted for melanoma in situ on the head and neck; however, the consensus is not as clear when it comes to invasive cutaneous melanoma, she says. A wide local excision of invasive melanoma with margins from 1 cm to 2 cm remains the standard of care; but, recent data indicate that Mohs surgery can achieve treatment outcomes equal, if not better than, the traditional wide local excision technique in early-stage invasive melanoma, she says.
Moreover, Mohs surgery used in invasive melanoma has also been shown to result in lower recurrence rates compared to a standard wide local excision, especially on the head and neck.
Removing a melanoma with these wide margins can be challenging in certain areas, such as the eyelid or nose where less tissue is available. In these areas, Dr. Council says that surgeons may rely on the disclaimer in current guidelines that allows for removing less tissue in these complex areas. The National Comprehensive Cancer Network (NCCN) guidelines state that a surgeon may modify margins for an individual due to anatomic or functional considerations.
Dr. Council reports that she is a consultant for Sanofi-Genzyme/Regeneron.