1st order laboratory parameters – obligatory laboratory tests.
- Small blood count
- Differential blood count
- Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
- LDH (lactate dehydrogenase) – initial at ≥ 4 mm tumor thickness, with ulceration (examination in stage IIC and III).
- AP (alkaline phosphatase)
- 5-Cysteinyldopa (tumor marker; biochemical marker for malignant melanoma) [limit: 400 ug/d (1.3 umol/d]
Laboratory parameters 2nd order (follow-up/therapy control).
- Protein S 100 (S-100 protein); indication: from stage IB – determination:
- Initial at ≥ 0.8 mm tumor thickness, no ulceration < 4 mm, with ulceration + ≥ 4 mm, with ulceration.
- Year 1-3 every three months. [Follow-up and prognosis evaluation in malignant melanoma]Studies demonstrate the value of protein S-100 (in serum) in the diagnosis and follow-up of malignant melanoma.The sensitivity (percentage of diseased patients in whom the disease is detected by the use of the test, i.e., a positive test result occurs) depends on the stage of spread of malignant melanoma:
- Primary tumor stage: 4-10%.
- Regional lymph node metastases: 9-20 %.
- Distant metastasis: 70-80%.
In follow-up examinations, increasing values indicate tumor progression and decreasing values are indicative of remission.
- Eosinophil cationic protein (ECP) [High serum ECP levels correlate with poorer overall survival, regardless of treatment modality] (Note: this was a small study!).
- Testing for mutations (stage III and above) – preparatory for subsequent systemic therapy [testing can be done on primary tumor as well as sentinel lymph node; in recurrence, testing on tissue of current metastases).
- BRAF mutation (50%)
- NRAS, KRAS(Kirsten-RAS) or HRAS (Harvey-RAS) mutation (25%).
- NF1 mutation (15%)
- Melanoma with none of the above gene mutations (triple wild type; 10%.
Testing for c-kit gene for activating mutations (5%) in acral and mucosal melanomas (“”belonging to the extremity ends”” melanomas and mucosal melanomas).
