Stage IA T1aN0M0 no adverse features

Breslow ≤ 1mm

T1a: no ulceration (U-), Clark level ≤ III

10 yr survival = 87.9%

  Margins Mohs? SLN bx PET CT Radiation Adjuvant

ESMO 1 cm no no no no no no

NCCN 1 cm no no no no no no

U of Iowa 1 cm* no** no no noconsider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

Stage IA T1aN0M0 adverse features: mitotic rate >1 mm2, LVI

Breslow ≤ 1mm

T1a: no ulceration (U-), Clark level ≤ III

  Margins Mohs? SLN bx PET CT Radiation Adjuvant

ESMO 1 cm no no no no no no

NCCN 1 cm no yes no no no no

U of Iowa 1 cm* no** yes*** no noconsider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

***comment: consider SLN bx: >0.75 mm invasion, other listed adverse features; SLN not useful

desmoplastic melanoma

Stage IB T1bN0M0

Breslow ≤ 1mm

T1b:with ulceration or Clark level IV or V

  Margins Mohs? SLN bx PET CT Radiation Adjuvant

ESMO 1 cm no no no no no no

NCCN 1 cm no yes no no no no

U of Iowa 1 cm* no** yes*** no noconsider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

***comment: consider SLN bx: >0.75 mm invasion, other listed adverse features; SLN not useful

desmoplastic melanoma

Stage IB T2aN0M0

Breslow 1.01-2.0 mm

T2a: no ulceration

  Margins Mohs? SLN bxPET CT Radiation Adjuvant

ESMO

NCCN 1 - 2 cm no yes no# no# no no

U of Iowa 1 -2 cm* no** yes*** no# no#consider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

***comment: consider SLN bx: >0.75 mm invasion, other listed adverse features; SLN not useful

desmoplastic melanoma

#comment: PET/CT imaging may be useful to evaluate signs/symptoms but are not routine.

Stage IIA T2bN0M0

Breslow 1.01-2.0 mm

T2b: with ulceration

  Margins Mohs? SLN bxPET CT Radiation Adjuvant

ESMO

NCCN 1 - 2 cm no yes no# no# no no

U of Iowa 1 -2 cm* no** yes*** no# no#consider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

***comment: consider SLN bx: >0.75 mm invasion, other listed adverse features; SLN not useful

desmoplastic melanoma

#comment: PET/CT imaging may be useful to evaluate signs/symptoms but are not routine.

Stage IIA T3aN0M0

Breslow 2.01-4.0 mm

T3a: no ulceration

  Margins Mohs? SLN bxPET CT Radiation Adjuvant

ESMO

NCCN 2 cm no yes no# no# no no

U of Iowa 2 cm* no** yes*** no# no#consider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

***comment: consider SLN bx: >0.75 mm invasion, other listed adverse features; SLN not useful

desmoplastic melanoma

#comment: PET/CT imaging may be useful to evaluate signs/symptoms but are not routine.

Stage IIB T3bN0M0

Breslow 2.01-4.0 mm

T3b: with ulceration

  Margins Mohs? SLN bxPET CT Radiation Adjuvant

ESMO

NCCN 2 cm no yes no# no# no no

U of Iowa 2 cm* no** yes*** no# no#consider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

***comment: consider SLN bx: >0.75 mm invasion, other listed adverse features; SLN not useful

desmoplastic melanoma

#comment: PET/CT imaging may be useful to evaluate signs/symptoms but are not routine.

Stage IIB T4aN0M0

Breslow >4.0 mm

T4a: no ulceration

  Margins Mohs? SLN bxPET CT Radiation Adjuvant

ESMO

NCCN 2 cm no yes no# no# no no

U of Iowa 2 cm* no** yes*** yes yesconsider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

***comment: consider SLN bx: >0.75 mm invasion, other listed adverse features; SLN not useful

desmoplastic melanoma

#comment: PET/CT imaging may be useful to evaluate signs/symptoms but are not routine.

Stage IIC T4bN0M0

Breslow >4.0 mm

T4b: with ulceration

  Margins Mohs? SLN bxPET CT Radiation Adjuvant

ESMO

NCCN 2 cm no yes no# no# no no

U of Iowa 2 cm* no** yes*** yes yesconsider: PNI, desmoplastic no

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

***comment: consider SLN bx: >0.75 mm invasion, other listed adverse features; SLN not useful

desmoplastic melanoma

#comment: PET/CT imaging may be useful to evaluate signs/symptoms but are not routine.

Stage III T - any N - positive M - 0

  Margins Mohs? SLN bx PET CT Radiation Adjuvant

ESMO

NCCN per T no no yes yes yes yes

U of Iowa per T* no** no yes yes yes yes

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma

Stage IV T - any N - any M - 0

  Margins Mohs? SLN bx PET CT Radiation Adjuvant

ESMO

NCCN per T no no yes yes yes yes

U of Iowa per T* no** no yes yes yes yes

*comment: margins are not inviolate and may be modified by proximity to critical

structures with attention to lymphatic drainage patterns

**comment: Mohs surgery may be considered for melanoma with lentigo maligna

extending beyond the 1 margin encompassing melanoma