Clinicopathological Features, Staging, and Current Approaches to Treatment in High-Risk Resectable Melanoma

Abstract The incidence of melanoma in the United States has been increasing over the past several decades. Prognosis largely depends on disease stage, with 5-year melanoma-specific survival ranging from as high as 99% in patients with stage I disease to less than 10% for some patients with stage IV...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 2020-09, Vol.112 (9), p.875-885
Main Authors: Keung, Emily Z, Gershenwald, Jeffrey E
Format: Article
Language:English
Subjects:
Biopsy
Clinical trials
Health services
Humans
Immune checkpoint
Lymph nodes
Lymphatic Metastasis
Lymphatic system
Margins of Excision
Medical Oncology - methods
Medical Oncology - trends
Medical prognosis
Melanoma
Melanoma - epidemiology
Melanoma - pathology
Melanoma - surgery
Melanoma - therapy
Metastases
Metastasis
Neoadjuvant Therapy - methods
Neoadjuvant Therapy - trends
Neoplasm Staging
Patients
Prognosis
Risk
Risk Assessment
Sentinel Lymph Node Biopsy
Skin Neoplasms - epidemiology
Skin Neoplasms - pathology
Skin Neoplasms - surgery
Skin Neoplasms - therapy
Surgical Procedures, Operative - methods
Surgical Procedures, Operative - trends
Survival
United States - epidemiology
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Summary:Abstract The incidence of melanoma in the United States has been increasing over the past several decades. Prognosis largely depends on disease stage, with 5-year melanoma-specific survival ranging from as high as 99% in patients with stage I disease to less than 10% for some patients with stage IV (distant metastatic) disease. Fortunately, in the last 5–10 years, there have been remarkable treatment advances for patients with high-risk resectable melanoma, including approval of targeted and immune checkpoint blockade therapies. In addition, results of recent clinical trials have confirmed the importance of sentinel lymph node biopsy and continue to refine the approach to regional lymph node basin management. Lastly, the melanoma staging system was revised in the eighth edition AJCC Cancer Staging Manual, which was implemented on January 1, 2018. Here we discuss these changes and the clinicopathological features that confer high risk for locoregional and distant disease relapse and poor survival. Implications regarding the management of melanoma in the metastatic and adjuvant settings are discussed, as are future directions for neoadjuvant therapies.
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/djaa012