Consensus on the management of melanoma of the skin in The Netherlands. Dutch Melanoma Working Party.

In 1990, the Dutch Melanoma Working Party, in cooperation with the National Organization for Quality Assurance in Hospitals, organised the second consensus conference on the management of melanoma of the skin. The following guidelines were approved: The margin of a therapeutical excision should be 1 cm for melanomas not thicker than 1.0 mm, 2 cm for a thickness of 1.1-2.0 mm, 3 cm for a thickness of 2.1-3.0 mm. No consensus was reached for tumours thicker than 3.0 mm. The conclusion of the histopathological report should state the histological type of melanoma, the thickness, the level of invasion, the presence of ulceration, regression, microsatellitosis and completeness of removal. In melanomas between 1.5 mm and 4 mm, elective lymph node dissection may be considered, but its value has not been proven. Clinically suspicious regional lymph nodes require a therapeutical lymph node dissection, solitary lymph node removal is inappropriate. Prophylactic (adjuvant) regional perfusion in primary melanoma should only be performed in the context of a clinical trial. Regional perfusion is the treatment of choice for satellitosis and/or in-transit metastases of the extremities without evidence of distant metastases. If radiotherapy is indicated, high fractionation doses are required. There is no standard therapy for distant metastases. Routine check radiographs and laboratory studies are unnecessary during the follow-up period. The follow-up period is normally 10 years.