Practical Manual for Dermatologic and Surgical Melanoma Management

Description

This book provides a practically applicable resource for all clinicians managing patients with or who may develop melanoma. Each chapter focuses on clinically relevant information on the latest advances in the field, including techniques for early detection of skin cancers, cross-sectional imaging and staging of regional nodes. Algorithms for clinical decision-making along with clinical vignettes are incorporated into each chapter, enabling the reader to develop a deep understanding of how to manage a range of scenarios. Practical Manual for Dermatologic and Surgical Melanoma Management systematically details the latest diagnostic criteria, treatment guidelines and management techniques available for treating these patients and is a valuable resource for the trainee and practising clinician.   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