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Review
January 19, 2017

Contemporary Management of Early-Stage MelanomaA Systematic Review

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
  • 2Department of Dermatology, University of Michigan, Ann Arbor
JAMA Facial Plast Surg. Published online January 19, 2017. doi:10.1001/jamafacial.2016.1846
Key Points

Question  What is the current standard of care for management of early-stage melanoma?

Findings  This systematic review finds that surgical excision continues to be the standard of care, with margins based on the presence and depth of invasion. Sentinel lymph node biopsy plays a central role in the staging and treatment of melanoma.

Meaning  Accurate diagnosis and adequate surgical excision are critical in reducing local recurrences and improving outcomes. Sentinel lymph node biopsy is useful in staging the regional nodal basin and guiding treatment in appropriately selected patients.

Abstract

Importance  The incidence of melanoma is increasing, with 76 380 new cases of invasive melanoma and 68 480 new cases of melanoma in situ expected in 2016.

Objective  To review the contemporary management of early-stage melanoma.

Evidence Review  We searched PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews databases from January 1, 2011, to May 1, 2016, yielding 966 articles. We focused our search on early-stage (melanoma in situ, stage I, and stage II) cutaneous melanoma. After excluding articles, 41 articles were manually reviewed. A review of the bibliographies of selected articles generated additional references.

Findings  While the majority of recent advances have been in the treatment of advanced melanoma, surgical excision with margins based on the presence and depth of invasion continues to be the cornerstone of management. Sentinel lymph node biopsy plays a central role in the staging and treatment of melanoma.

Conclusions and Relevance  Accurate diagnosis and adequate surgical excision are critical in reducing local recurrences and improving outcomes. Sentinel lymph node biopsy is useful in staging the regional nodal basin and guiding treatment in appropriately selected patients.

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