Standards, Options and Recommendations (SOR): clinical practice guidelinesfor diagnosis, treatment and follow-up of cutaneous melanoma

Context: The "Standards, Options and Recommendations" (SOR) project, starte d in 1993, is a collaboration between the Federation of the French Cancer C entres (FNCLCC), the 20 French Cancer Centres and specialists from French P ublic Universities, General Hospitals and Private Clinics. The main objecti ve is the development of clinical practice guidelines to improve the qualit y of health care and outcome for cancer patients. The methodology is based on literature systematic review and critical appraisal by a multidisciplina ry group of experts, with feedback from specialists in cancer care delivery . Objectives: To develop clinical practice guidelines according to the defi nitions of Standards, Options and Recommendations for the management of pat ients with cutaneous melanoma. Methods: Data have been identified by litera ture search using Medline - until December 1998 - and the personal referenc e lists of the expert group. Once the guidelines were defined, the document was submitted for review to national and international independent reviewe rs and to the medical committees of the 20 French Cancer Centres. Results: The main recommendations for the management of cutaneous melanoma (CM) are: 1) The primary prevention of melanoma is based on a reduction in exposure to ultraviolet rays (solar or artificial). 2) The diagnosis of CM requires the surgical removal and histological examination of the lesion (standard). 3) The pathological report must include the diagnosis of primary malignant melanoma, the maximum thickness of the tumour in millimeters (Breslow), th e clearance of surgical margins, the level of invasion (Clark), the presenc e and extension of regression and the presence of any ulceration (standard) . 4) The standard treatment of a primary melanoma without lymph node involv ement is based on surgery that must ensure adequate margins depending on th e thickness of the tumour (standard, level of evidence B). 5) After surgery of a stage 1 melanoma, there is no indication for additional treatment out side a prospective therapeutic study (standard, level of evidence B, French Consensus Conference). 6) For a local recurrence without node involvement, in the absence of other metastases, surgical excision is the standard trea tment. 7) In the case of metastatic regional lymph nodes, a complete region al lymphadenectomy is required. There is no indication for additional treat ment outside a prospective therapeutic study (standard, level of evidence B ). The inclusion of these patients in controlled studies of immunotherapy i s recommended. 8) There is no standard therapeutic strategy for metastatic melanoma. Conventional palliative treatment is chemotherapy with dacarbazin e (level of evidence B). 9) Follow-up is based on physical examination (sta ndard). Patient information must encourage self-surveillance. Clinical surv eillance and self-detection are indicated in all cases throughout life (sta ndard).