From the Guidelines
After a dermatologist removes a melanoma, the next step typically involves pathological examination of the removed tissue to confirm complete removal and determine the cancer's characteristics, followed by a surveillance plan that includes regular skin examinations and potentially additional treatments based on the melanoma's stage. The patient will need follow-up appointments for wound care, suture removal (usually within 1-2 weeks), and to discuss pathology results. Based on the melanoma's depth (Breslow thickness), stage, and other features, the dermatologist will develop a surveillance plan that may include:
- Regular skin examinations every 3-6 months for the first few years, then annually 1
- Additional treatments might be necessary depending on the melanoma's stage, such as a wider excision, sentinel lymph node biopsy, immunotherapy, targeted therapy, or radiation
- Patients should perform monthly self-skin examinations
- Practice sun protection (using broad-spectrum SPF 30+ sunscreen, wearing protective clothing, and avoiding peak sun hours) 1
- Inform close relatives about their diagnosis since melanoma risk has a genetic component Some key points to consider in the follow-up plan include:
- The risk of recurrence, previous primary melanoma, and family history of melanoma 1
- The presence and extent of dysplastic nevi and patient anxiety 1
- The optimal duration of follow-up remains controversial, but most patients who have recurrent disease will present in the first 5 years after treatment 1 Regular imaging or blood tests may be recommended for higher-risk melanomas to monitor for recurrence or spread, but the use of imaging techniques is not universally agreed upon and should be individualized based on the patient's risk factors 1.
From the FDA Drug Label
The efficacy of KEYTRUDA was investigated in KEYNOTE-716 (NCT03553836), a multicenter, randomized (1:1), double-blind, placebo-controlled trial in patients with completely resected Stage IIB or IIC melanoma. The major efficacy outcome measure was investigator-assessed recurrence-free survival (RFS) The trial demonstrated a statistically significant improvement in RFS and DMFS for patients randomized to the KEYTRUDA arm compared with placebo
The next step after a dermatologist removes a melanoma is to consider adjuvant treatment with KEYTRUDA to help prevent the melanoma from coming back. This is based on the results of the KEYNOTE-716 trial, which showed that KEYTRUDA significantly improved recurrence-free survival (RFS) and distant metastasis-free survival (DMFS) in patients with completely resected Stage IIB or IIC melanoma 2.
From the Research
Next Steps after Melanoma Removal
After a dermatologist removes a melanoma, the next steps may involve:
- Adjuvant therapy to prevent the recurrence of melanoma 3, 4
- Monitoring for any signs of recurrence or metastasis 5
- Discussion of treatment options, such as immunotherapy or targeted therapy, depending on the stage and severity of the melanoma 6, 3, 4
Adjuvant Therapy Options
Some adjuvant therapy options that may be considered include:
- Nivolumab, which has been shown to improve recurrence-free survival in patients with resected stage III or IV melanoma 3
- Pembrolizumab, which has been shown to improve event-free survival in patients with resectable stage III or IV melanoma when given both before and after surgery 4
- Interferon alpha-2a, although a study found that it did not improve disease-free or overall survival in patients with regional node metastases from cutaneous melanoma 7
Importance of Early Detection and Treatment
Early detection and treatment of melanoma are crucial for improving survival rates 5 Melanoma misdiagnosis can significantly reduce a patient's chances of survival, highlighting the need for accurate diagnosis and timely treatment 5