Understanding a sentinel lymph node biopsy service for patients with malignant melanoma.

Malignant melanoma cases represented the seventh most common cancer type in Northern Ireland between 2011 and 2015, and the incidence of melanoma cases is expected to rise. Sentinel lymph node biopsy (SLNB) is commonly offered to patients in the UK with malignant melanoma to help in staging their disease, but a commissioned SLNB service is not available in Northern Ireland. This article describes a Florence Nightingale Foundation Travel Scholarship to gain knowledge and experience with the aim of developing and implementing an effective and efficient SLNB service for patients with malignant melanoma in Northern Ireland. A 3-week visit was made to an eminent centre of excellence in skin oncology in the UK.

MAPK Pathway-Targeted Therapies: Care and Management of Unique Toxicities in Patients With Advanced Melanoma
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BACKGROUND: Agents targeting the MAPK pathway, including inhibitors of BRAF and MEK, have dramatically transformed the treatment landscape for patients with BRAF-mutant metastatic melanoma. Although generally well tolerated, targeted agents were associated with unique toxicities.
. OBJECTIVES: This article aims to provide nurses with an overview of the key toxicities and associated management strategies of the characteristic adverse event (AE) profile associated with agents targeting the MAPK pathway.
. METHODS: Data from clinical trials evaluating vemurafenib, dabrafenib, trametinib, and cobimetinib were reviewed and summarized along with research on management of AEs identified in clinical trials.
. FINDINGS: The key AEs associated with these agents included pyrexia and cutaneous toxicities. Other notable AEs included arthralgias, ocular toxicities, and cardiac events. Because these agents are administered until progressive disease or unacceptable toxicity, nurses should be aware of management strategies to optimize treatment outcomes.

Employing patient-reported outcome (PRO) measures to support newly diagnosed patients with melanoma: Feasibility and acceptability of a holistic needs assessment intervention.

PURPOSE: Living with a melanoma diagnosis can be challenging. We aimed to assess the feasibility, acceptability, and perceived value of a nurse-led intervention that utilised patient-reported outcome (PRO) measures to identify and address the supportive care needs of newly diagnosed patients with Stage I/II melanoma over the first 4 months post-diagnosis. METHODS: We conducted an exploratory, repeated-measures, single-arm, feasibility trial. One baseline (4 weeks post-diagnosis; T1) and one follow-up intervention session (4 weeks after wide local excision; T3) took place, two months apart. Patient survey data were collected monthly, at four assessment points (T1-T4), followed by exit interviews. RESULTS: A recruitment rate of 55% (10/18) was achieved. The skin cancer nurse specialist (CNS) performed 19 in-clinic patient assessments within 6 months. One patient missed their follow-up intervention session (90% retention rate). Three participants (30%) were lost to follow-up at T4. Patients endorsed the standardised use of easy-to-use PRO measures as a means to help them shortlist, report and prioritise their needs. The CNS viewed the intervention as a highly structured activity that allowed tailoring support priority needs. A sizeable reduction in information needs was found from T1 to T4 (Standardised Response Mean [SRM] change = -0.99; p < 0.05). From T1 to T2, significant reductions in psychological (SRM change = -1.18; p < 0.001), practical (SRM change = -0.67; p < 0.05) and sexuality needs (SRM change = -0.78; p < 0.05) were observed. CONCLUSIONS: The intervention appears to be feasible in clinical practice and acceptable to both patients with newly diagnosed melanoma and clinicians. Future research is warranted to test its effectiveness against standard care.

Intralesional Therapy: Consensus Statements for Best Practices in Administration From the Melanoma Nursing Initiative
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BACKGROUND: Talimogene laherparepvec (T-VEC) is the first intralesional therapy for melanoma approved by the U.S. Food and Drug Administration. This oncolytic viral immunotherapy has improved outcomes for patients with locoregional recurrent melanoma and is showing promise in combination with systemic therapies. 
. OBJECTIVES: This article aims to provide oncology nurses with expert guidance on best practices in incorporating intralesional therapy for patients diagnosed with melanoma in practice. 
. METHODS: Members of the Melanoma Nursing Initiative explored issues related to administration of T-VEC in melanoma. The current literature and clinical experiences were reviewed. 
. FINDINGS: The author offers a care step pathway (CSP) and commentary detailing best practices in infection control, drug storage, pharmacy interface, patient flow, space/staff allocation, patient education, and adverse event management with T-VEC. The CSP will help nurses improve patient outcomes and streamline the workflow with this novel therapeutic approach.

BRAF/MEK 
Inhibitor Therapy: Consensus Statement From the Faculty of the Melanoma Nursing Initiative on Managing Adverse Events and Potential Drug Interactions.

BACKGROUND: BRAF/MEK inhibitor therapy improves outcomes in BRAF V600E- and V600K-mutated unresectable or metastatic melanoma. However, these regimens are associated with adverse events (AEs) that may lead to unnecessary drug modifications and discontinuations or potentially serious sequelae. In addition, drug-drug interactions (DDIs) may result in AEs or altered therapeutic efficacy.
. OBJECTIVES: This article presents consensus statements to guide nurses in the prevention, recognition, and management of AEs and potential DDIs associated with BRAF/MEK inhibitor therapy. 
. METHODS: Members of the Melanoma Nurse Initiative reviewed the current literature and clinical experience related to AEs and DDIs associated with BRAF/MEK inhibitor therapy. 
. FINDINGS: The care step pathways provided for select AEs represent a proactive, comprehensive nursing care plan to support optimal patient outcomes. Recommendations are also offered for preventing and managing DDIs.

Collaborative Care in Melanoma: The Essential Role of the Nurse
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This article provides perspective from medical oncologists on the importance of this supplement from the Melanoma Nursing Initiative. The authors (a) delineate the challenges inherent in addressing adverse event (AE) management with newer melanoma therapies, particularly in the community setting; (b) illustrate how advanced practice providers with extensive clinical trial experience in melanoma are in a key position to set the agenda and educate colleagues on best practices in AE management; and

Promoting Oral Therapy Adherence: Consensus Statements From the Faculty of the Melanoma Nursing Initiative on Oral Melanoma Therapies
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BACKGROUND: Inhibitors of BRAF and the downstream signaling protein MEK have improved outcomes for patients with BRAF-mutant advanced malignant melanoma. Despite their ease of administration, these oral therapies pose adherence challenges. 
. OBJECTIVES: This article aims to increase awareness of causes of nonadherence to oral targeted therapies in advanced malignant melanoma and to provide oncology nurses with strategies to address these nonadherence issues. 
. METHODS: Members of the Melanoma Nursing Initiative explored issues related to adherence to targeted therapies in advanced malignant melanoma. The current literature and clinical experience were reviewed. 
. FINDINGS: The authors present a care step pathway focused on increased patient engagement and rapid identification and optimal management of toxicities to avoid toxicity-related nonadherence. Other causes for nonadherence and employment of individualized strategies to support patient adherence are addressed.

Ipilimumab-Based
 Therapy: Consensus Statement From the Faculty of the Melanoma Nursing Initiative on Managing Adverse Events With Ipilimumab Monotherapy and Combination Therapy With Nivolumab.

BACKGROUND: Ipilimumab (Yervoy®) therapy improves outcomes in patients with resected stage III melanoma, and ipilimumab alone or combined with nivolumab (Opdivo®) does so in those with unresectable or metastatic melanoma. These immunotherapies are associated with immune-related adverse events (irAEs). With prompt recognition and appropriate management, serious sequelae or unnecessary treatment discontinuation can be prevented.
. OBJECTIVES: This article presents consensus statements to guide oncology nurses in the recognition and management of irAEs associated with ipilimumab and nivolumab. 
. METHODS: Members of the Melanoma Nursing Initiative reviewed the current literature and clinical experience regarding nursing interventions related to irAEs associated with ipilimumab or ipilimumab and nivolumab therapy.
. FINDINGS: The care step pathways provided represent a proactive, evidence-based, and comprehensive plan to support optimal patient outcomes.

Advances in Melanoma: The Rationale for the Melanoma Nursing Initiative
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This article provides an overview of this supplement, outlining the needs assessment process the Melanoma Nursing Initiative (MNI) used to determine the immunotherapy and targeted therapy topics for discussion as well as the process for developing the consensus statements. The article provides specific discussion of a unique feature of the MNI, the care step pathways (CSPs) for management of adverse events (AEs) associated with melanoma therapies, and looks to the future in terms of the potential benefits of engaging and enabling oncology nurses to adopt a standardized approach to AE management and adherence promotion for melanoma therapies.

PD-1 Inhibitor Therapy: Consensus Statement From the Faculty of the Melanoma Nursing Initiative on Managing Adverse Events
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BACKGROUND: Programmed cell death protein 1 (PD-1) inhibitor therapies are now a standard treatment for advanced melanoma and other tumor types. The immune-related adverse events (irAEs) associated with PD-1 inhibitor therapy are drastically different from the AEs associated with chemotherapy. Because these irAEs reflect immune system activation rather than side effects of therapy, nurses should be cognizant of the range of organ systems potentially affected as well as likely clinical presentations.
. OBJECTIVES: This article presents consensus statements to guide nurses in the recognition and management of irAEs associated with PD-1 inhibitor monotherapy for advanced melanoma.
. METHODS: Members of the Melanoma Nursing Initiative discussed the current literature and clinical experience regarding nursing interventions related to irAEs associated with PD-1 inhibitor therapy.
. FINDINGS: The care step pathways provided for select irAEs represent a proactive, comprehensive nursing care plan to support optimal outcomes for patients receiving PD-1 inhibitor therapy.

Checkpoint Inhibitors: Common Immune-Related Adverse Events and Their Management
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BACKGROUND: Immunotherapy, specifically the use of checkpoint inhibitors, offers patients with cancer an alternative to chemotherapy, targeting different pathways to destroy cancer cells. The side effects of immunotherapies, as well as their impact on normal tissue, need to be assessed and managed based on their mechanisms of action. OBJECTIVES: This article presents an overview of immune-related adverse events (AEs). 
. METHODS: Common immune-related toxicities, as well as rare and refractory toxicities, are reviewed. 
. FINDINGS: Immunotherapy treatment is an option for many patients with cancer, and nurses must understand the distinct side effect profile of these agents. Prompt identification and expert management are the cornerstones of success when dealing with immune-related AEs, and oncology nurses play a key role in improving patient care.

Ultraviolet Radiation Exposure and Its Impact on Skin Cancer Risk.

OBJECTIVES: To review research and evidence-based resources on skin cancer prevention and early detection and their importance for oncology nurses. DATA SOURCES: Journal articles, federal reports, cancer surveillance data, behavioral surveillance data. CONCLUSION: Most cases of skin cancer are preventable. Survivors of many types of cancer are at increased risk of skin cancers. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can play an important role in protecting their patients from future skin cancer morbidity and mortality.

[The nurses involved in therapeutic innovation]. / Infirmière de recherche clinique en onco-dermatologie.

Clinical research nurses (CRNs) play an important role within the teams involved in the fight against cancer and in therapeutic innovation. In the dermatology department of the Gustave-Roussy Institute, patients treated for melanoma and taking part in clinical trials are supported along their care pathway by a CRN who, in addition to her clinical expertise, acts as a link between the different players concerned.

[Global management of melanoma in the palliative phase]. / Le mélanome en phase palliative, une prise en charge globale.

The priority of the care management of people with melanoma in the palliative stage is to treat symptoms causing discomfort and to provide psychological support. The commitment of caregivers is important, both on the professional as well as human level. A team in Lyon shares its practices.

Precision medicine in oncology standard of care.

OBJECTIVES: To review the histologic subtypes and staging of non-small cell lung cancer and metastatic melanoma, as well as the molecular markers used to direct standard therapy. DATA SOURCES: Book chapters and journal articles from medical and nursing literature, as well as published clinical guidelines. CONCLUSION: Patients with metastatic non-small cell lung cancer and metastatic melanoma have had a paucity of treatment options, most fraught with toxicity with limited benefit. Increased understanding of tumor genetics and molecular markers has expanded the treatment options for these patients, often providing them with durable responses and improved quality of life. IMPLICATIONS FOR NURSING PRACTICE: To provide education and support to their patients, nurses caring for these patients need to understand the role that genetics and molecular markers play in directing these therapies.