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MANAGEMENT OF PRIMARY MELANOMA

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The incidence of melanoma is increasing worldwide. In the United States, it is estimated that there will be 76,380 new cases of invasive melanoma and 68,480 cases of melanoma in situ diagnosed in the year 2016.1 Despite an overall decline in cancer rates, melanoma is one of the few cancers with an increasing incidence.2 As summarized in other chapters, many elements of contemporary diagnosis and management of melanoma are guided by decades of clinical data and experience, but there is evidence of significant variation in practice patterns.

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In the setting of sufficient uncertainty (or controversy) about treatment recommendations, clinicians often refer to clinical practice guidelines when establishing treatment plans for their patients. Because of the sheer volume of medical literature clinicians are faced with, practice guidelines offer an ideal means of synthesizing data to inform evidence-based care for patients. Numerous guidelines for the treatment of melanoma exist and are readily available to clinicians (Table 19-1). Ideally, guideline development is based on a systematic review of the literature by content and methodologic experts, with thoughtful evaluation of data leading to practical recommendations for multidisciplinary patient care.

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TABLE 19-1

Summary of Primary Treatment Guidelines

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