Practical Manual for Dermatologic and Surgical Melanoma Management

Contents
Chapter 1: Can We End Melanoma As We Know It? The Role of Early Detection in Defeating Deadly Skin Cancer
	Introduction
	Case
	Additional Clinical History
	Melanoma Risk Factors
	Physical Exam Findings
	Discussion
	Critical Take Home Messages
	References
Chapter 2: Melanoma Risk Factors and Prevention
	Introduction
	Case
		Melanoma Disparities
		Risk Factors
			Phenotypic Features
			Personal Medical History
			Genetic Predisposition/Family History
			Environmental Factors
		Screening
		Prevention
	Discussion of Case
	Conclusions
	References
Chapter 3: The Laboratory Evaluation of Melanoma
	Introduction
	Case
		Histopathology
		Immunohistochemistry
			Diagnostic IHC
			Prognostic and Therapeutic IHC
				BRAF and MEK
				c-Kit
				Immune Checkpoints (CTLA4/PD-1/PD-L1)
		Molecular Assays
			Comparative Genomic Hybridization (CGH) and Single Nucleotide Polymorphism (SNP) Arrays
			Fluorescence in Situ Hybridization (FISH)
		Molecular Assays-Diagnostic/Prognostic
			RNA-Base Gene Expression Profiling (Quantitative Reverse Transcription Polymerase Chain Reaction-qRT-PCR)
			Liquid (Serologic) Biomarkers
			Mutational Load
		Sentinel Lymph Nodes (SLN)
	Discussion of Case
	Conclusions
	References
Chapter 4: Melanoma Epidemiology, Staging and Prognostic Factors
	Introduction
	Melanoma Epidemiology
	Melanoma Staging
	Prognostic Factors in Melanoma
		Depth of Invasion
		Ulceration
		Mitotic Rate
		Growth Phase and Melanoma Subtypes
		Regression
		Tumor Infiltrating Lymphocytes
		Lymphatic Invasion and Angiotropism
		Neurotropism
		Nevus Association
		Age
		Gender
		Marital Status
		Anatomical Location
		Tumor Derived Markers
		Molecular Markers of Melanoma Prognosis
		Conditional Survival
	Summary
	References
Chapter 5: Imaging in Melanoma
	Lymphoscintigraphy for Sentinel Node Biopsy
		Lymphoscintigraphy Technique
		Possible Radiation Risk of LS
		Potential Problems with LS
			Wide Local Excision (WLE)
			Reproducibility
			The Melanoma Site Immediately Overlies a Node Field
		Conclusion
	Ultrasound in Melanoma Patients
		Diagnosis
			Patient Case
			Does US Have a Role in Primary Assessment of Melanoma?
		Staging
			Case Continued
			What Are the US Criteria for Defining Normal and Abnormal Lymph Nodes?
			What Is the Role of US Assessment of the Regional Lymph Node Basins Before Sentinel Node Mapping and/or Biopsy?
		Follow Up
			Case Continued
			How Is US Used in Follow Up?
			Conclusion
	Cross Sectional Imaging
		Staging
			Early Stage Disease
			Later Stage Disease
		Monitoring the Effects of Therapy
		Post Treatment Surveillance
		Effect on Survival
		Conclusion
	References
Chapter 6: Primary Melanoma Treatment
	Case
	Introduction
	Operative Primary Melanoma Treatment
		Wide Excision
			Technique
			Recommended Margins for Wide Excision
			Clinical vs Pathologic Margins
			Areas of Uncertainty
				Melanoma In Situ
				Melanomas 1–2 mm in Depth
				Melanoma >4 mm in Depth
				Lymph Node Involvement
			Challenging Situations
				Lentigo Maligna Melanoma
				Acral Lentiginous Melanoma
	Non-operative Treatment for Primary Melanoma
		Potential Reasons for Non-operative Management
		Topical Therapies
			Topical Imiquimod
			Topical Diphencyprone
		Intralesional Injections
			Bacillus Calmette-Guerin (BCG) Injection
			Talimogene Laherparepvec (T-VEC) Injections
			Interleukin-2 (IL-2) Injections
			Rose Bengal/PV-10
		Radiation Therapy
		Systemic Therapy
	Conclusion/Case Discussion
	Critical Take Home Points
	References
Chapter 7: Regional Nodal Staging: Clinically Node Negative
	Introduction
	History
	Patient Selection for Sentinel Lymph Node Biopsy
		Guideline Recommendations
		Evidence for Intermediate-Thickness and Thick Melanomas
		Evidence for Thin Melanomas
	Technical Performance
		Lymphoscintigraphy and Tracer Injection
		Performance of Sentinel Lymph Node Biopsy
		Specimen Handling
	Pathologic Assessment of the Sentinel Lymph Node
		Specimen Sectioning
		Specimen Staining and Tumor Burden Assessment
	Summary
	References
Chapter 8: Regional Melanoma Therapy: Positive Sentinel Lymph Node
	Case
	Introduction
	Prognostic Assessment
	Completion Lymph Node Dissection
	Clinical Follow Up
	Adjuvant Therapy
		Radiation Therapy
		Medical Therapy
	Conclusion
	References
Chapter 9: Regional Therapies: Clinically-Apparent Nodal Disease
	Case
	Epidemiology
	Diagnosis
	Staging
	Management
		Cervical Lymphadenectomy
		Axillary Lymphadenectomy
		Superficial and Deep Groin Lymphadenectomy
		Adequacy of Lymphadenectomy
		Morbidity of Lymphadenectomy
		Minimally Invasive Lymphadenectomy
	Adjuvant Systemic Therapy
	Radiation Therapy
	Outcomes
	Surveillance
	Future Directions
	References
Chapter 10: Surgery for Stage IV Melanoma
	Clinical Case
	Introduction
	Evolution of Surgical and Systemic Therapy for Stage IV Melanoma
	Patient Selection for Metastasectomy
		Staging
		Prognostic Considerations
		Morbidity
		Timing of Therapies
		Purpose of Surgical Intervention
	Site-Specific Considerations
		M1a Disease
		M1b Disease
		M1c Disease
		M1d Disease
	Summary and Conclusion
	Clinical Case: Conclusion
	Take Home Messages
	References
Index