Contemporary management of locoregionally advanced melanoma in Australia and New Zealand and the role of adjuvant systemic therapy. (20th July 2021)

• Record Type: Journal Article
• Authors: Smithers, B. Mark; Saw, Robyn P. M.; Gyorki, David E.; Martin, Richard C. W.; Atkinson, Victoria; Haydon, Andrew; Roberts‐Thomson, Rachel; Thompson, John F.
• Is Part Of: ANZ journal of surgery. Volume 91(2021)supplement 2
• Page Start: 3
• Page End: 13
• Publication Date: 2021-07-20
• Subjects: adjuvant drug therapy -- cutaneous melanoma -- immunotherapy -- sentinel node biopsy -- staging -- targeted therapy; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.17051
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Australia and New Zealand have the highest incidence and mortality rates for melanoma in the world. Local surgery is still the standard treatment of primary cutaneous melanoma, and it is therefore important that surgeons understand the optimal care pathways for patients with melanoma. Accurate staging is critical to ensure a reliable assessment of prognosis and to guide treatment selection. Sentinel node biopsy (SNB) plays an important role in staging and the provision of reliable prognostic estimates for patients with cutaneous melanoma. Patients with stage III melanoma have a substantial risk of disease recurrence following surgery, leading to poor long‐term outcomes. Systemic immunotherapies and targeted therapies, known to be effective for stage IV melanoma, have now also been shown to be effective as adjuvant post‐surgical treatments for resected stage III melanoma. These patients should be made aware of this and preferably managed in an integrated multidisciplinary model of care, involving the surgeon, medical oncologists and radiation oncologists. This review considers the impact of a recent update to the American Joint Committee on Cancer (AJCC) staging system, the role of SNB for patients with high‐risk primary melanoma and recent advances in adjuvant systemic therapies for high‐risk patients. Abstract : The impact of the AJCC eighth edition staging of cutaneous melanoma, along with effective systemic therapies, have had a major impact on the management of high‐risk primary melanoma. This article summarises the staging implications of sentinel node biopsy, the outcomes from recent adjuvant therapy trials for stage III melanoma and the linkage between the management of the primary high‐risk melanoma to access to these new therapies.