1.
According to NCCN guidelines, when should complete lymph node dissection be performed for melanoma?: Patients with clinically positive nodes and without evidence of distant mets (Stage III) should have wide local excision and complete dissection of the involved nodal basin.
After a positive sentinal node biopsy, complete lymph node dissection should be offered, however the impact on regional control and survival is unclear at this time (2011). An ongoing trial is assising this.
2.
According to NCCN recomendations, when is imaging indicated in the workup of melanoma?: Basically only for evaluation of clinically suspected mets. Routine screening imaging isn't recommended. Consider full body imaging when a distant met has been found to rule out other distant mets if it will change treatment decisions.
3.
AJCC M staging for melanoma?: M1a: Mets to skin, subcutaneous, or distant lymph nodes.
M1b: Mets to lung.
M1c: Mets to all other visceral sites or any site combined with elevated serum LDH.
4.
AJCC N staging for melanoma?: 
5.
AJCC T staging for melanoma?: Tis: in situ
T1: ≤ 1.0 mm
T2: 1.01-2.0 mm
T3: 2.01-4.0 mm
T4: >4.0 mm
For T1:
a: w/o ulceration and < 1/mm²
b: with ulceration or ≥ 1/mm²
For T2-4:
a: w/o ulceration
b: with ulceration
6.
NCCN recommendations for margins of excision of melanoma?: Depth Margin
In-situ 0.5 cm
≤ 1 mm 1.0 cm
1.01-2.0 mm 1-2 cm
>2.0 mm 2.0 cm
Based on several randomized trials that found no survival (and usually no local control) differences between narrow (1 cm) and wide margins (3-4 cm).
7.
Possible adjuvant treatments for positive margins after excision of lentigo maligna in cosmetically sensitive areas?: Topical imiquimod or radiotherapy.
8.
Stage for a T4aN0M0 cutaneous melanoma?: Stage IIb
9.
What are the best predictors of positive sentinal node biopsy?: Breslow thickness, mitotic rate, and young age.
Young age must be combined with high mitotic rate. Young age alone is not sufficient cause for performing SLN.
10.
What are the most important tumor characteristics predicting outcome in patients with localized cutaneous melanoma (no regional nodes or distant mets)?: 1. Tumor thickness.
2. Presence of ulceration.
3. For tumors ≤ 1.0 mm, mitotic rate.
11.
What defines stage III for melanoma?
What defines stage IV?
What are the 5-year survival rates?: Stage III: Any T, ≥ N1, M0. 20-70% survival depending on nodal burden.
Stage VI: Any T, any N, M1. < 10% survival.
12.
What is the 5-year survival for a localized melanoma ≤ 1.0 mm? What about localized disease > 1.0 mm?: ≤ 1.0 mm: 90%
> 1.0 mm: 50-90%
13.
What is the benefit of a sentinal node dissection for cutaneous melanoma?
According to NCCN guidelines, who should be offered a sentinal lymph node dissection for melanoma?: Currently it only provides staging and prognosis information. No improvement in regional control or survival for completion lymphadenectomy based on SLN results has been demonstrated (as of 2011). The MSLT-II is investigating this.
NCCN recommends SLN for:
Stage IB: T1b (≤ 1 mm thick with ulceration or mitotic rate ≥ 1/mm²), N0M0
Stage II: T2-4, N0M0 (>1.0 mm thick)
14.
What's the highest stage for localized melanoma without regional nodes or distant mets?: Stage II.
