Analyzing Controversies in Management and Surveillance of Early-Stage Melanoma

摘要

The incidence of cutaneous melanoma continues to rise dramatically worldwide [1, 2]. According to the National Cancer Institute, there will be over 100,000 new cases of cutaneous melanoma in the United States in 2020, continuing the trend of a constant increase over almost three decades [3]. Cohort studies in Europe demonstrate similar trends and indicate that a further increase in incidence rates is expected in the future [4]. Melanoma presents a considerable public health and a significant cost burden to the healthcare system, having the highest cost per death and the highest loss of productive life-years among all cancers in countries with high incidence [1, 2]. Despite this, there is still controversy in the guidelines regarding follow-up surveillance for patients with thin melanoma. Thin melanomas are those with a Breslow depth that ranges between 0.1 and 1.0 mm and represent approximately 70% of all new cases [5]. Treatment is surgical excision with a 1-cm margin, while imaging is reserved only for symptomatic cases [6]. Sentinel lymph node biopsy should be discussed and considered for patients with T1b melanomas, which are those with either 0.8–1 mm depth or < 0.8 mm depth with ulceration [6]. The majority of these patients are managed exclusively by their general dermatologist [5]. Because of the limited number of randomized clinical trials to support evidence-based guidelines for follow-up surveillance, dermatologic and oncologic organizations have developed their own recommendations based on expert opinion [7].