This handout is for cutaneous melanoma (dermatology lens). Your care team identified this based on: new, changing, or symptomatic pigmented lesion meeting abcde / ugly-duckling criteria (aad 2019 primary cutaneous melanoma pmid 30392755).
Other reasons your team may use this plan: rapidly growing elevated firm nodule (efg) — incl. amelanotic/pink nodular melanoma which classically defeats abcde (aad 2019 pmid 30392755); pigmented nail band with proximal-nail-fold pigment spread (hutchinson sign) → subungual melanoma until biopsy proven otherwise (aad 2019 pmid 30392755); total-body skin exam in a high-risk patient (≥50 nevi / atypical-mole syndrome, personal/family melanoma, cdkn2a, chronic immunosuppression, prior intense uv) (aad 2019 pmid 30392755).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| wide_local_excision_stage_based_margins | — | — | — | AAD 2019 (PMID 30392755) — definitive treatment of primary cutaneous melanoma: clinical margins by Breslow — in situ 0.5–1.0 cm; ≤1.0 mm → 1 cm; >1–2 mm → 1–2 cm; >2 mm → 2 cm — excised to (not through) deep fascia. |
| sentinel_lymph_node_biopsy | — | — | — | AAD 2019 (PMID 30392755) / MSLT-I (Morton/Faries NEJM 2014 PMID 24521106) — SLNB is the most powerful prognostic stratifier; offer/discuss at ≈T1b (≥0.8 mm or <0.8 mm with ulceration) and all ≥T2; performed at the same setting as WLE. |
| nodal_ultrasound_surveillance_instead_of_completion_lymphadenectomy | — | — | — | MSLT-II (Faries NEJM 2017 PMID 28591523) — immediate completion lymphadenectomy did NOT improve melanoma-specific survival vs nodal ultrasound surveillance for SLN+; nodal US surveillance is the default, completion dissection reserved for selected cases. |
| staged_or_mohs_excision_for_lentigo_maligna | — | — | — | AAD 2019 (PMID 30392755) — staged excision / Mohs with exhaustive margin assessment for lentigo maligna at anatomically constrained head/neck sites where standard wide margins are unfeasible. |
| imiquimod | 5% cream | topical | 5×/week ×12 wk (regimens vary) | AAD 2019 (PMID 30392755) — off-label topical imiquimod is an option for lentigo maligna when surgery is declined/unfeasible or as a margin adjunct; lower clearance than surgery, requires close follow-up. |
| definitive_radiotherapy_for_lentigo_maligna | — | — | — | AAD 2019 (PMID 30392755) — definitive radiotherapy is an accepted non-surgical option for lentigo maligna in patients who are not surgical candidates. |
Plan: Cutaneous melanoma — stage-directed ladder (AAD 2019 + AJCC8; systemic routed to oncology)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Lifelong derm continuity: scheduled total-body skin exams (second-primary risk is elevated for life — ~ up to 5–10% lifetime second melanoma), structured skin self-examination + partner-assisted nail/scalp/acral checks, photoprotection counselling, surveillance imaging cadence by stage, and first-degree-relative + CDKN2A familial counselling (incl. pancreatic-cancer surveillance discussion in CDKN2A kindreds). Re-stage and re-route to oncology on recurrence/in-transit/new-primary; reconcile any checkpoint-inhibitor cutaneous irAE with derm.drug-eruption.core.v1.
Guideline: AAD 2019 Guidelines of care for the management of primary cutaneous melanoma (Swetter et al, JAAD; PMID 30392755, DOI 10.1016/j.jaad.2018.08.055) + AJCC 8th edition cutaneous-melanoma staging (Gershenwald) + MSLT-I final report (Morton/Faries, NEJM 2014; PMID 24521106) + MSLT-II (Faries, NEJM 2017; PMID 28591523) + CheckMate 067 5-yr (Larkin/Wolchok, NEJM 2019; PMID 31562797) + KEYNOTE-006 (Robert, NEJM 2015; PMID 25891173; 7-yr PMID 37348035) + COMBI-d/v 5-yr pooled (Robert, NEJM 2019; PMID 31166680) + CheckMate 238 adjuvant 5-yr (Larkin, CCR 2023; PMID 37058595) + KEYNOTE-716 adjuvant stage IIB/C (Luke, Lancet 2022; PMID 35367007) + SWOG S1801 neoadjuvant (Patel, NEJM 2023; PMID 36856617)