Treatment of Localised Primary Cutaneous Amelanocytic Melanoma Without Nodal or Distant Metastases

This protocol addresses the management of amelanocytic melanoma presenting as a localised primary cutaneous tumour — with no evidence of nodal involvement or distant spread.

Clinical situation

Patients in this scenario have primary cutaneous disease that is localised, without regional nodal or distant metastatic involvement. The management approach is guided by tumour characteristics including thickness.

Treatment approach

The primary intervention involves full-depth surgical excision of the tumour. Safety margins are determined by tumour characteristics. For selected patients where surgical excision is not feasible, a non-surgical local control strategy may be considered.

Complete margin guidance, patient selection criteria, and the full structured regimen are available via the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2024.11.006

Full depth, wide local excision (WLE) of primary tumours (with safety margins of 0.5 cm for in situ melanomas, 1 cm for tumours with a thickness of 2 mm and 2 cm for tumours thicker than 2 mm) is recommended.
Full depth, WLE of primary tumours with safety margins of 0.5 cm for in situ melanomas, 1 cm for tumours with a thickness 2 mm and 2 cm for tumours >2 mm is recommended [III, B].
Definitive radiotherapy (RT) to the primary tumour can only be considered in carefully selected patients for local control when excision is not possible either due to severe patient comorbidities (e.g. very old age, end-stage cardiovascular disease, etc.), when the morbidity associated with the excision is considered unacceptable or when surgery is refused by the patient.

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