Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

966 Melanoma

Regional Metastases

■Surgery

■Hyperthermic regional limb perfusion

■Adjuvant therapy – interferon alpha-2b

■Adjuvant therapy – experimental melanoma vaccines

Distant Metastases (Stage IV) Melanoma

■Radiation

■Chemotherapy

■Chemoimmunotherapy

■Biologic therapy (interferon, interleukins, monoclonal antibodies,

melanoma vaccines)

follow-up

Total skin examinations for melanoma and its precursors should be

routinely done.

■Localized disease – follow q3 months for the 1st year, then q6 months

for the next 5 years, yearly thereafter.

■Locoregional metastasis(nodal metastasis) – follow q3 months for

2 years after the excision, then q6 months

➣Serum LDH and chest x-ray tests at each visit. PET/CT scan at

initial staging and then q6 months. Additional studies directed

toward symptoms.

■Distant metastases – q3 months for 5 years, then q6 months

➣Radiologic and laboratory investigations dependent upon symp-

toms and exam (i.e., cervical lymphadenopathy – CT scan)

complications and prognosis

Stage I Melanoma

■Sex – women > men

■Tumor site –back, posteriorarm, posteriorneck,scalp (BANS) worse

prognosis

■Age younger > older

■Tumor thickness – thin > thick

➣<0.76 mm, 96% 5-year survival

➣0.76–1.49, 87%

➣1.50–2.49, 75%

➣2.50–3.99, 66%

➣>4.0, 47%

■Clark’s level of invasion

➣Intraepidermal (Level I)

➣In papillary dermis (Level II)

➣Fills papillary dermis (Level III)