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NCCN Guidelines and Compendium Updated

Flash Update Sent September 21, 2011

NCCN has published updates to the NCCN Guidelines and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Melanoma. These NCCN Guidelines are currently available as Version 2.2012.

Workup for Stage IV, Metastatic Disease

  • Footnote "r" regarding biopsy changed to "Obtain tissue for genetic analysis if the patient is being considered for targeted therapy or if it is relevant to eligibility for participation in a clinical trial.


Treatment of Metastatic Disease

  • For patients with disseminated (unresectable) disease, without brain metastases, the option of systemic therapy changed to "Systemic therapy and/or Radiation."


Principles of Radiation Therapy

  • Primary Disease
  • The following statement was removed: "Special cases where complete surgical excision is not possible or not recommended due to potential morbidity."
  • Bullet changed to "Adjuvant treatment for selected patients with desmoplastic melanoma with extensive neurotrophism."


Systemic Therapy Options For Advanced or Metastatic Melanoma

  • Based on the supporting data and recent FDA approval, vemurafenib (category 1) was added as an option for the treatment of patients with advanced or metastatic melanoma. The following corresponding footnotes were also added:
  • Footnote "4": Vemurafenib is recommended for patients with V600 mutation of the BRAF gene documented by an FDA-approved or Clinical Laboratory Improvement Amendments (CLIA)-approved facility.
  • Footnote "5": Vemurafenib has the potential for significant dermatologic complications including cutaneous squamous cell carcinoma and extreme photosensitivity. Regular dermatologic evaluation with referral to a dermatologist as clinically indicated. Patients should also be carefully monitored for the development of other adverse reactions such as joint pain and swelling.


Flash Update Sent August 12, 2011

NCCN has published updates to the NCCN Guidelines for Melanoma. These NCCN Guidelines are currently available as Version 1.2012.

  • For pathology report, the recommendation to include "Pure desmoplasia if present" has a new footnote that states, "Given the very low rates of sentinel lymph node positivity with pure desmoplastic melanoma, when a pure desmoplastic lesion is suspected, it is important that an experienced dermatopathologist examine the entire lesion before making the decision to perform a sentinel lymph node biopsy (SLNB)."
  • In regards to sentinel node biopsy for Stage IA, IB, and II, the corresponding footnote was revised as follows: "For lower risk patients, such as those with IA lesions and IB lesions ≤ 0.5mm thick and mitotic rate < 2 per mm2, SLNB should generally not be recommended, unless there are specific adverse features (category 2B)."
  • For Principles of Biopsy, a new bullet was added that states, "The orientation of the biopsy should be planned with definitive wide excision in mind."
  • For Principles of Pathology, the fifth bullet was revised as follows "Consider use of comparative genomic hybridization (CGH) or fluorescent in situ hybridization (FISH) for histologically equivocal lesions." A new corresponding footnote was also added that states, "CGH may be more accurate than FISH in identifying relevant genetic mutations."
  • Systemic Therapy Options For Advanced Or Metastatic Melanoma: For ipilimumab, a new footnote was added that states, "Re-induction with ipilimumab may be considered for select patients who experienced no significant systemic toxicity during prior ipilimumab therapy and who relapse after initial clinical response or progress after stable disease > 3 months."

For the complete updated version of these and all NCCN Guidelines, visit