Dysplastic nevus medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

The mainstay of therapy for dysplastic nevus is surgery, however radiation therapy or chemotherapy may be administered in metastatic disease.

Medical treatment

Dysplastic nevi are associated with increased risk of melanoma, management includes risk evaluation along with other procedures. The mainstay of therapy for dysplastic nevus is surgery, however radiation therapy or chemotherapy may be incorporated in metastatic disease. Surgical excision of dysplastic nevi is generally recommended with a positive histologic margin.

Dysplastic nevi can be categorized into risk categories:

  • Mildly, mildly-to-moderately, and moderately dysplastic nevi generally appearing as low-risk lesions,
  • Moderately-to-severely and severely dysplastic nevi appearing to carry a higher risk for coexistent or future melanoma.

Chemotherapy regimens

Chemotherapy, however, is indicated for the following patient subgroups:

  • Patients with high risk melanomas (Stage IIB-IV) - Adjuvant therapy using interferon therapy
  • Patients with metastatic disease - First-line therapy using either a single agent or combination regimen.
  • Several single agent and combination regimens have been studied, all with modest impact on survival.

*All current guidelines still recommend enrollment in clinical trials over current available regimens for patients with metastatic disease. Below is a summary of available adjuvant and treatment regimens.

Adjuvant therapy[1]

  1. Interferon alfa-2a (Roferon-A)
  2. Interferon alfa-2b (Intron-A)
  3. Peginterferon alfa-2b (Sylatron)

Metastatic or unresectable melanoma[1]

Either a single agent chemotherapy OR a combination chemotherapy is recommended for metastatic or unresectable melanoma.

  • Single Agent Chemotherapy
  1. Dabrafenib (Tafinlar)
  2. Dacarbazine (DTIC)
  3. Docetaxel (Taxotere)
  4. Interleukin-2 (high dose or maintenance biotherapy)
  5. Imatinib (Gleevec)
  6. Ipilimumab (Yervoy)
  7. Nivolumab (Opdivo)
  8. Paclitaxel (Taxol)
  9. Pembrolizumab (Keytruda)
  10. Temozolomide (Temodar)
  11. Trametinib (Mekinist)
  12. Vemurafenib (Zelboraf)
  • Combination Chemotherapy
  1. Paclitaxel nanoparticle albumin-bound + Bevacizumab + Carboplatin (ABC)
  2. Carboplatin + Paclitaxel
  3. Carboplatin + Paclitaxel + nanoparticle albumin-bound
  4. Carboplatin + Paclitaxel +, Sorafenib
  5. Cisplatin + Dacarbazine ± Carmustine
  6. Cisplatin + Dacarbazine + IL-2 + IFN alfa-2b ± Carmustine
  7. Cisplatin + Paclitaxel + Dacarbazine
  8. Cisplatin + Vinblastine + Dacarbazine
  9. Cisplatin + Vinblastine + Dacarbazine + IL-2 + IFN alfa-2b (sequential biochemotherapy)
  10. Temozolomide + Bevacizumab
  11. Dabrafenib + Trametinib
  12. Ipilimumab + Dacarbazine
  13. Ipilimumab + Nivolumab

References

  1. 1.0 1.1 Peter Yang and Jeremy Warner. Melanoma. Hemonc.org. Accessed on August 21, 2015. http://hemonc.org/wiki/Melanoma

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