Melanoma – Current Guidelines for Treament and Follow-up


Authors: I. Krajsová
Authors‘ workplace: Dermatovenerologická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. Jiří Štork, CSc.
Published in: Čes-slov Derm, 93, 2018, No. 1, p. 4-16
Category: Reviews (Continuing Medical Education)

Základem účinné léčby melanomu je jeho včasné rozpoznání a chirurgické odstranění. V případech pokročilých melanomů s vysokým rizikem metastazování, je nutné uvažovat o adjuvantní terapii, která by dokázala progresi zcela zabránit nebo jí alespoň oddálit. Léčebné postupy účinné v terapii metastazujícího melanomu prokázaly podle nejnovějších výsledků klinických studií účinnost i v adjuvantním podávání. Základem současné léčby metastazujícího melanomu je imunoterapie zaměřená na kontrolní body imunity CTLA-4 a PD-1 a cílená léčba u BRAF V600 pozitivních nádorů.

Overview

Effective treatment of melanoma is based on its early recognition and surgical excision. In case of advanced melanomas with high risk of metastases, the adjuvant therapy that prevents recurrence or increases progression free survival should be considered. Based on the new clinical trials the treatment modalities used in metastatic melanoma therapy are effective in adjuvant setting as well. Checkpoint inhibition immunotherapy CTLA-4 and PD-1 and targeted therapy in BRAF V600 positive tumors is the mainstay treatment for metastatic melanoma. Both of them show significant increase response rates, significantly prolonged progression-free survival and overal survival rates compared to chemotherapy. This type of treatment is concentrated in specialized centres due  to its high cost and specificity. Thus patients with advanced melanoma should be reffered to such centres primarily to enable an early diagnosis of tumor recurrence and initiation of an appropriate and the most effective treatment.

Key words:

melanoma – diagnostics – adjuvant therapy – targeted therapy – immunotherapy – follow-up


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