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Eur J Cancer. 2020 Jan 9. pii: S0959-8049(19)30833-0. doi: 10.1016/j.ejca.2019.11.014. [Epub ahead of print]

European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics - Update 2019.

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Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany. Electronic address:
Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany; Portuguese Air Force Health Care Direction, Lisbon, Portugal.
Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
Department of Dermatovenerology, Third Faculty of Medicine, Charles University of Prague, Prague, Czech Republic.
Department of Oncology, Odense University Hospital, Denmark.
Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK.
Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France.
Department of Dermatology, University of L'Aquila, Italy.
University Department of Dermatology, Marseille, France.
Department of Dermatology, Medical University of Vienna, Austria.
Department of Dermatology, Venerology and Allergology, Frankfurt University Hospital, Frankfurt, Germany.
First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
APHP Department of Dermatology, INSERM U976, University Paris 7 Diderot, Saint-Louis University Hospital, Paris, France.
Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain.
NIHR Biomedical Research Center, University of Oxford, UK.
Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France.
1st Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece.
Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy.
Princess Máxima Center, 3584 CS, Utrecht, the Netherlands.


Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed through dermatoscopy. If a melanoma is suspected, a histopathological examination is required. Sequential digital dermatoscopy and full-body photography can be used in risk persons to detect the development of melanomas at an earlier stage. Where available, confocal reflectance microscopy can improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the AJCC classification. Thin melanomas up to 0.8 mm tumor thickness does not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC whole-body examinations with CT or PET-CT in combination with brain MRI are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to support the frequency and extent of examinations. A stage-based follow-up scheme is proposed, which, according to the experience of the guideline group, covers the minimum requirements; further studies may be considered. This guideline is valid until the end of 2021.


AJCC classification; Confocal reflectance microscopy; Cutaneous melanoma; Dermatoscopy; Follow-up examinations; Imaging diagnostics; Mutation testing; Primary diagnosis; Sequential digital dermatoscopy; Total body photography

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