Шкірна меланома
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DIS-MELANOMA |
|---|---|
| Тип | Хвороба |
| Синоніми | MelanomaШкірна меланома |
| Статус | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-ESMO-MELANOMA-2024 SRC-NCCN-MELANOMA-2025 |
Інформаційна підтримка. Усі рекомендації має перевірити кваліфікований онколог. Технічні перевірки не є клінічною валідацією чи схваленням лікування.
| icd_o_3_morphology | 8720/3 |
|---|---|
| icd_o_3_topography | ["C44.9"] |
| icd_10 | C43 |
| who_classification | Malignant melanoma of skin (WHO 5th 2023) |
Нотатки
Біомаркер-керований архетип: статус BRAF визначає вибір між таргетною терапією та інгібіторами контрольних точок (ICI). При метастазах у головний мозок перевагу надають комбінованій ICI-терапії (дублету).
Де використовується
Algorithms
ALGO-COWDEN-CARRIER-SURVEILLANCE- ALGO-COWDEN-CARRIER-SURVEILLANCEALGO-HEREDITARY-MELANOMA-SURVEILLANCE- ALGO-HEREDITARY-MELANOMA-SURVEILLANCEALGO-MELANOMA-ADJUVANT-1L- ALGO-MELANOMA-ADJUVANT-1LALGO-MELANOMA-METASTATIC-1L- ALGO-MELANOMA-METASTATIC-1LALGO-MELANOMA-METASTATIC-2L- ALGO-MELANOMA-METASTATIC-2L
Handbook Chapters
HB-MELANOMA-METASTATIC-1L- Metastatic melanoma: BRAF / IO first-line reasoning
Questionnaires
QUEST-MELANOMA-1L-STUB- Cutaneous melanoma — first line
Sources
SRC-BREAK-3-HAUSCHILD-2012- Dabrafenib in BRAF-mutated metastatic melanoma: a multicentre, open-label, phase 3 random...SRC-BRIM-3-CHAPMAN-2011- Improved Survival with Vemurafenib in Melanoma with BRAF V600E MutationSRC-C14401-CHESNEY-2024- Efficacy and safety of lifileucel, a one-time autologous tumor-infiltrating lymphocyte (T...SRC-CARVAJAL-KIT-MELANOMA-2013- KIT as a therapeutic target in metastatic melanomaSRC-CHECKMATE-067-LARKIN-2019- Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced MelanomaSRC-CHECKMATE-238-WEBER-2017- Adjuvant Nivolumab versus Ipilimumab in Resected Stage III or IV MelanomaSRC-COBRIM-LARKIN-2014- Combined Vemurafenib and Cobimetinib in BRAF-Mutated MelanomaSRC-COLUMBUS-DUMMETT-2018- Encorafenib plus binimetinib versus vemurafenib or encorafenib in patients with BRAF-muta...SRC-COMBI-AD-LONG-2017- Adjuvant Dabrafenib plus Trametinib in Stage III BRAF-Mutated MelanomaSRC-COMBI-D-LONG-2014- Combined BRAF and MEK Inhibition versus BRAF Inhibition Alone in MelanomaSRC-COMBI-V-ROBERT-2015- Improved Overall Survival in Melanoma with Combined Dabrafenib and TrametinibSRC-ESMO-MELANOMA-2024- ESMO Cutaneous MelanomaSRC-KEYNOTE-006-ROBERT-2015- Pembrolizumab versus Ipilimumab in Advanced MelanomaSRC-KEYNOTE-022-ASCIERTO-2019- Dabrafenib, trametinib and pembrolizumab or placebo in BRAF-mutant melanoma (KEYNOTE-022)SRC-KEYNOTE-054-EGGERMONT-2018- Adjuvant Pembrolizumab versus Placebo in Resected Stage III MelanomaSRC-NCCN-MELANOMA-2025- NCCN Cutaneous MelanomaSRC-RELATIVITY-047-TAWBI-2022- Relatlimab and Nivolumab versus Nivolumab in Untreated Advanced Melanoma
Клінічна застосовність
BMA-BRAF-V600E-MELANOMA- BRAF V600E (and V600K) in cutaneous melanoma is the prototypical driver: combination BRAF...BMA-BRAF-V600K-MELANOMA- BRAF V600K (~10-20% of BRAF-mutant melanomas) shares all BRAF/MEKi approvals with V600E....BMA-BRCA2-GERMLINE-MELANOMA- BRCA2 germline pathogenic confers ~2-3× elevated cutaneous melanoma risk and uveal-melano...BMA-BRCA2-SOMATIC-MELANOMA- Somatic BRCA2 loss-of-function in melanoma: no PARPi indication; biological rationale onl...BMA-KIT-MUTATION-MELANOMA- KIT mutation in mucosal / acral / chronic-sun-damaged melanoma (~15-20% of these subtypes...BMA-KRAS-Q61-MELANOMA- KRAS Q61 (rare in melanoma; NRAS Q61 is more common) — MEKi monotherapy modest activity (...BMA-NRAS-G12-MELANOMA- NRAS G12/G13 — rarer than Q61 mutations in melanoma. Same MEKi/ICI rationale extrapolated.BMA-NRAS-G13-MELANOMA- NRAS G13 in melanoma — limited data; treat per NRAS-mut algorithm.BMA-NRAS-Q61K-MELANOMA- NRAS Q61K — same therapeutic rationale as Q61R. ICI 1L; binimetinib NEMO subgroup.BMA-NRAS-Q61R-MELANOMA- NRAS Q61R is the most common NRAS hotspot in melanoma (~20% of cutaneous melanomas). Bini...BMA-TP53-MUT-MELANOMA- TP53 mutation in MELANOMA — common, adverse prognostic; not directly targeted. Per usual...
Показання
IND-FAMMM-CARRIER-INTENSIFIED- IND-FAMMM-CARRIER-INTENSIFIEDIND-FAMMM-CARRIER-SURVEILLANCE- IND-FAMMM-CARRIER-SURVEILLANCEIND-LIFESTYLE-UV-EXPOSURE-PREVENTION-OBSERVATION- IND-LIFESTYLE-UV-EXPOSURE-PREVENTION-OBSERVATIONIND-LIFESTYLE-UV-EXPOSURE-PREVENTION-PROTECTION- IND-LIFESTYLE-UV-EXPOSURE-PREVENTION-PROTECTIONIND-MELANOMA-2L-KIT-IMATINIB- IND-MELANOMA-2L-KIT-IMATINIBIND-MELANOMA-2L-POST-BRAFI-IPI-NIVO- IND-MELANOMA-2L-POST-BRAFI-IPI-NIVOIND-MELANOMA-2L-POST-IO-BRAFI-MEKI- IND-MELANOMA-2L-POST-IO-BRAFI-MEKIIND-MELANOMA-2L-RELATLIMAB-NIVOLUMAB- IND-MELANOMA-2L-RELATLIMAB-NIVOLUMABIND-MELANOMA-3L-LIFILEUCEL- IND-MELANOMA-3L-LIFILEUCELIND-MELANOMA-3L-POST-LIFILEUCEL- IND-MELANOMA-3L-POST-LIFILEUCELIND-MELANOMA-ADJUVANT-PEMBRO-STAGE-III- IND-MELANOMA-ADJUVANT-PEMBRO-STAGE-IIIIND-MELANOMA-BRAF-METASTATIC-1L-DABRA-TRAME- IND-MELANOMA-BRAF-METASTATIC-1L-DABRA-TRAMEIND-MELANOMA-METASTATIC-1L-NIVO-IPI- IND-MELANOMA-METASTATIC-1L-NIVO-IPIIND-MELANOMA-METASTATIC-1L-PEMBRO-MONO- IND-MELANOMA-METASTATIC-1L-PEMBRO-MONOIND-MELANOMA-NIVO-MAINT- IND-MELANOMA-NIVO-MAINT
Тривожна ознака
RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK- Patient with active or incompletely controlled pre-existing autoimmune or inflammatory di...RF-BAP1-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in the BAP1 gene — BAP1 tumor p...RF-CDKN2A-SPECIFIC-PDAC-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in CDKN2A (p16/INK4a) — gene-sp...RF-ENVIRONMENTAL-OUTDOOR-UV-SKIN-PREVENTION- Chronic high cumulative occupational outdoor UV exposure (≥10 years outdoor work in high-...RF-FAMMM-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in the CDKN2A (p16-INK4a) gene...RF-LIFESTYLE-UV-EXPOSURE-PREVENTION- High cumulative ultraviolet radiation exposure — including chronic occupational/recreatio...RF-MELANOMA-BRAF-V600-ACTIONABLE- BRAF V600E or V600K activating mutation in metastatic / unresectable melanoma — ~40-50% p...RF-MELANOMA-FRAILTY-AGE- Age ≥80 + ECOG ≥2 — nivo+ipi prohibitive; nivo+rela or pembro mono.RF-MELANOMA-HIGH-RISK-BIOLOGY- BRAF V600E/K OR NRAS mutation — drives BRAFi+MEKi vs ICI doublet decision.RF-MELANOMA-INFECTION-SCREENING- Active or latent infection requiring resolution / prophylaxis before initiating ICI (anti...RF-MELANOMA-IO-RESISTANT- IO-resistant metastatic melanoma — progression on prior anti-PD-1 (± anti-CTLA-4 or anti-...RF-MELANOMA-KIT-MUT-ACTIONABLE- KIT activating mutation (exon 11 / 13) in mucosal or acral melanoma subtype — ~15-20% pre...RF-MELANOMA-NF1-MUT-CANDIDATE- Cutaneous melanoma with somatic NF1 loss-of-function mutation (frameshift / nonsense / sp...RF-MELANOMA-ORGAN-DYSFUNCTION- LDH >2x ULN OR severe hepatic dysfunction — predictor of inferior ICI outcomes.RF-MELANOMA-STAGE-III-RESECTED- Resected stage III cutaneous melanoma — adjuvant-eligible biology (positive sentinel-lymp...RF-MELANOMA-TRANSFORMATION-PROGRESSION- Symptomatic CNS metastases — ICI doublet (nivo+ipi) intracranially active; BRAFi+MEKi for...RF-OCC-FIREFIGHTER-PREVENTION- Documented historical occupational exposure as a career firefighter (≥10 years in active...RF-UVEAL-MELANOMA-BAP1-MUT-CANDIDATE- Uveal (intraocular — choroidal, ciliary-body, iris) melanoma with somatic BAP1 loss-of-fu...RF-WERNER-CONFIRMED-CARRIER- Confirmed biallelic germline pathogenic / likely-pathogenic variants in WRN (RECQL2; Wern...
Хвороба
DIS-BCC- Basal cell carcinoma (BCC)DIS-CHOROID-PLEXUS-CARCINOMA- Choroid plexus carcinomaDIS-RETINOBLASTOMA- Retinoblastoma