Abstract：
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 cutaneous melanoma diagnosis and treatment, based on the systematic literature reviews and the experts\' experience. Cutaneous melanomas are excised with one to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumor thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team (\"tumor board\"). Adjuvant therapies can be proposed in stage III/completely resected stage IV patients and are primarily anti-PD-1, independent of mutational status, or alternatively dabrafenib plus trametinib for BRAF mutant patients. In distant metastases (stage IV), either resected or not, systemic treatment is always indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In stage IV melanoma with a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harboring a BRAF-V600 E/K mutation, this therapy shall be offered as second-line therapy. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.
摘要：
来自欧洲皮肤病学论坛（EDF）的多学科专家的独特合作，欧洲皮肤病肿瘤学协会（EADO），并成立了欧洲癌症研究与治疗组织（EORTC），以就皮肤黑色素瘤的诊断和治疗提出建议，基于系统的文献综述和专家的经验。切除皮肤黑素瘤，安全范围为1至2厘米。前哨淋巴结清扫应作为肿瘤厚度≥1.0mm或≥0.8mm并有其他组织学危险因素的患者的分期程序。尽管这种方法还没有明确的生存益处。III/IV期患者的治疗决策应主要由跨学科肿瘤学团队（“肿瘤委员会”）做出。可以在III期/完全切除的IV期患者中提出辅助治疗，并且主要是抗PD-1，与突变状态无关。或dabrafenib联合曲美替尼治疗BRAF突变患者。在远处转移（IV期），切除或不切除，全身治疗总是指征。对于一线治疗，特别是在BRAF野生型患者中，应考虑单独使用PD-1抗体或与CTLA-4抗体联合使用的免疫治疗.在具有BRAF-V600E/K突变的IV期黑色素瘤中，BRAF/MEK抑制剂的一线治疗可替代免疫治疗.在对免疫疗法具有原发性耐药性并具有BRAF-V600E/K突变的患者中，该疗法应作为二线疗法提供。III/IV期黑色素瘤的全身治疗是一个快速变化的景观，这些建议很可能在不久的将来改变。
