AAD Releases New Guidelines for Melanoma Treatment

More than 1 million Americans are living with melanoma, the deadliest form of skin cancer, and one person dies of the disease every hour. Fortunately, melanoma is highly treatable when detected early.

As National Healthy Skin Month begins, officials with the American Academy of Dermatology (AAD) has released new guidelines to help pharmacists provide the best possible treatment for their patients with melanoma.

Developed by a work group composed of dermatologists, oncologists, and other experts in the field, the guidelines are based on the latest available evidence; new areas addressed include melanoma in pregnancy and genetic testing for hereditary risk.

According to the new guidelines, evidence is lacking that pregnancy increases a woman’s risk of developing melanoma or affects the prognosis of the disease. The guidelines indicate that any decisions regarding the management of melanoma in pregnant women should be based on patient health and disease stage, while counseling on future pregnancies should be based on the individual’s history and melanoma risk.

The guidelines also recommend that patients with a family history of melanoma receive education and counseling in genetic risk. According to the guidelines, formal genetic testing may not be appropriate and should be considered on an individual basis after the counseling discussion.

According to the guidelines, surgical excision remains the gold standard of melanoma treatment, while Mohs surgery or other forms of staged excision may be considered for certain subtypes of melanoma on some parts of the body. The guideline authors explained that although topical therapy or traditional radiation may be considered as second-line therapy in limited cases when surgery is not possible, electronic brachytherapy is not recommended for melanoma treatment due to a lack of scientific evidence.

When melanoma is detected in an early stage and treated before it spreads to the lymph nodes, the five-year survival rate is 99 percent, while patients with more advanced disease have lower survival rates. To facilitate early detection, the AAD encourages the public to conduct regular self-exams to look for signs of skin cancer and see a board-certified dermatologist if they notice any new or suspicious spots on their skin. The ABCDEs of melanoma highlight warning signs of the disease:

• Asymmetry: One half of a spot is unlike the other half.
• Border: A spot has an irregular, scalloped or poorly defined border.
• Color: A spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red or blue.
• Diameter: While melanomas are usually greater than 6 millimeters — or about the size of a pencil eraser — when diagnosed, they can be smaller.
• Evolving: A spot looks different from the rest or is changing in size, shape or color.

“If you notice any new spots on your skin, any spots that look different from the rest, or any spots that are changing, itching or bleeding, see a board-certified dermatologist,” AAD President Suzanne M. Olbricht, MD, FAAD, said in a press release about the recommendations. “Dermatologists have the expertise to accurately diagnose melanoma and provide patients with the highest-quality care.”

To find a board-certified dermatologist near you, visit aad.org/findaderm. For more information on melanoma, visit aad.org/public.

Reference

Swetter SM, Tsao H, Bichakjian CK, et al. Guidelines of care for the management of primary cutaneous melanoma. [published online November 1, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.08.055.