As National Healthy Skin Month begins, the American Academy of Dermatology’s (AAD) new melanoma guidelines shed light on risk of melanoma prognosis during pregnancy, the role of formal genetic testing in at-risk families and other aspects of care for primary cutaneous melanoma.
The new guidelines are published in the Journal of the American Academy of Dermatology.
According to the new guidelines, evidence is lacking that pregnancy increases a woman’s risk of developing melanoma or affects the prognosis of the disease. The guidelines indicate that any decisions regarding the management of melanoma in pregnant women should be based on patient health and disease stage, while counseling on future pregnancies should be based on the individual’s history and melanoma risk.
The guidelines also recommend that patients with a family history of melanoma receive education and counseling about genetic risk. According to the guidelines, formal genetic testing may not be appropriate and should be considered on an individual basis after the counseling discussion.
“Every case is unique, so physicians should work with their patients, and other specialists if necessary, to explain the available options and determine the best possible treatment plan for each patient,” says Hensin Tsao, MD, PhD, FAAD, co-chair of the guidelines work group. Dr. Tsao is also the Clinical Director of Mass General Melanoma & Pigmented Lesion Center, Director of the Melanoma Genetics Program, and a member of the Massachusetts General Hospital Cancer Center's Center for Melanoma in Boston.
Surgical excision remains the gold standard of melanoma treatment, while Mohs surgery or other forms of staged excision may be considered for certain subtypes of melanoma on some parts of the body, the guidelines state. Although topical therapy or traditional radiation may be considered as second-line therapy in limited cases when surgery is not possible, the guidelines do not recommend electronic brachytherapy for melanoma treatment due to a lack of scientific evidence.
When melanoma is detected in an early stage and treated before it spreads to the lymph nodes, the five-year survival rate is 99 percent, while patients with more advanced disease have lower survival rates. To facilitate early detection, the AAD encourages the public to conduct regular self-exams to look for signs of skin cancer and see a board-certified dermatologist if they notice any new or suspicious spots on their skin.