Kutanöz Melanomun Cerrahi Yönetimi ve Multidisipliner Yaklaşım

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Referanslar

Amaral T, Ottaviano M, Arance A, et al. Cutaneous melanoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. 2025;36(1):10-30. doi:10.1016/j.annonc.2024.11.006

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Cutaneous Melanoma. Version 2.2025. Erişim tarihi: 24 Ağustos 2025. Erişim adresi: https://www.nccn.org/guidelines.

Keung EZ, Gershenwald JE. The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. Expert Rev Anticancer Ther. 2018;18(8):775-784. doi:10.1080/14737140.2018.1489246

Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10.3322/caac.21834

Friedman RJ, Rigel DS, Kopf AW. Early Detection of Malignant Melanoma: The Role of Physician Examination and Self-Examination of the Skin. CA Cancer J Clin. 1985;35(3):130-151. doi:10.3322/canjclin.35.3.130

Abbasi NR, Shaw HM, Rigel DS, et al. Early Diagnosis of Cutaneous Melanoma. JAMA. 2004;292(22):2771. doi:10.1001/jama.292.22.2771

Scope A, Dusza SW, Halpern AC, et al. The “Ugly Duckling” Sign. Arch Dermatol. 2008;144(1). doi:10.1001/archdermatol.2007.15

Grob JJ. The “Ugly Duckling” Sign: Identification of the Common Characteristics of Nevi in an Individual as a Basis for Melanoma Screening. Arch Dermatol. 1998;134(1):103-a-104. doi:10.1001/archderm.134.1.103-a

Williams NM, Rojas KD, Reynolds JM, Kwon D, Shum-Tien J, Jaimes N. Assessment of Diagnostic Accuracy of Dermoscopic Structures and Patterns Used in Melanoma Detection. JAMA Dermatol. 2021;157(9):1078. doi:10.1001/jamadermatol.2021.2845

Dinnes J, Deeks JJ, Chuchu N, et al. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database of Systematic Reviews. 2018;2018(12). doi:10.1002/14651858.CD011902.pub2

Altamura D, Altobelli E, Micantonio T, Piccolo D, Fargnoli MC, Peris K. Dermoscopic Patterns of Acral Melanocytic Nevi and Melanomas in a White Population in Central Italy. Arch Dermatol. 2006;142(9). doi:10.1001/archderm.142.9.1123

Saida T, Koga H, Uhara H. Dermoscopy for acral melanocytic lesions: Revision of the 3-step algorithm and refined definition of the regular and irregular fibrillar pattern. Dermatol Pract Concept. Published online July 28, 2022:e2022123. doi:10.5826/dpc.1203a123

Ishihara Y, Saida T, Miyazaki A, et al. Early Acral Melanoma In Situ. Am J Dermatopathol. 2006;28(1):21-27. doi:10.1097/01.dad.0000187931.05030.a0

Iznardo H, Garcia-Melendo C, Yélamos O.

Lentigo Maligna: Clinical Presentation and Appropriate Management

. Clin Cosmet Investig Dermatol. 2020;Volume 13:837-855. doi:10.2147/CCID.S224738

Bollea-Garlatti LA, Galimberti GN, Galimberti RL. Lentigo maligno. Claves en el diagnóstico dermatoscópico. Actas Dermosifiliogr. 2016;107(6):489-497. doi:10.1016/j.ad.2016.01.001

Jaimes N, Chen L, Dusza SW, et al. Clinical and Dermoscopic Characteristics of Desmoplastic Melanomas. JAMA Dermatol. 2013;149(4):413. doi:10.1001/jamadermatol.2013.2248

Maher NG, Solinas A, Scolyer RA, Puig S, Pellacani G, Guitera P. Detection of desmoplastic melanoma with dermoscopy and reflectance confocal microscopy. Journal of the European Academy of Dermatology and Venereology. 2017;31(12):2016-2024. doi:10.1111/jdv.14381

Soyer HP, Jayasinghe D, Rodriguez-Acevedo AJ, et al. 3D Total-Body Photography in Patients at High Risk for Melanoma. JAMA Dermatol. 2025;161(5):472. doi:10.1001/jamadermatol.2025.0211

Hodgkinson T, Vereker C, Spencer A. Early detection of melanoma: evaluating the combined use of total body photography and sequential digital dermoscopic imaging in a national health service setting. Clin Exp Dermatol. 2025;50(7):1406-1408. doi:10.1093/ced/llaf094

Borroni R, Panasiti V, Valenti M, et al. Long-Term Sequential Digital Dermoscopy of Low-Risk Patients May Not Improve Early Diagnosis of Melanoma Compared to Periodical Handheld Dermoscopy. Cancers (Basel). 2023;15(4):1129. doi:10.3390/cancers15041129

Johnson MM, Leachman SA, Aspinwall LG, et al. Skin Cancer Screening: Recommendations for Data-Driven Screening Guidelines and a review of the US Preventive Services Task Force Controversy. Melanoma Manag. 2017;4(1):13-37. doi:10.2217/mmt-2016-0022

Royal College of Pathologists of Australasia (RCPA). Invasive Melanoma Structured Reporting Protocol. 3. baskı. 2023. Erişim tarihi: 25 Ağustos 2025. Erişim adresi: https://www.rcpa.edu.au/Library/Practising-Pathology/Structured-Pathology-Reporting-of-Cancer/Cancer-Protocols/Skin-Adnexal/Protocol-Melanoma.aspx.

International Collaboration on Cancer Reporting (ICCR). Invasive Melanoma Histopathology Reporting Guide. 2. baskı, Sürüm 2.0. 2019. Erişim tarihi: 25 Ağustos 2025. Erişim adresi: https://www.iccr-cancer.org/ICCR/media/Documents/ICCR-Melanoma-2nd-edn-v2-bookmark.pdf.

College of American Pathologists (CAP). Cancer Protocol Templates. Erişim tarihi: 25 Ağustos 2025. Erişim adresi: https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates.

Pathak S, Puckett Y. Cutaneous Malignant Melanoma: Guideline-Based Management and Interprofessional Collaboration. [Updated 2025 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572149/?utm_source.

Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(6):472-492. doi:10.3322/caac.21409

Swetter SM, Tsao H, Bichakjian CK, et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2019;80(1):208-250. doi:10.1016/j.jaad.2018.08.055

Janz TA, Neskey DM, Nguyen SA, Lentsch EJ. Is imaging of the brain necessary at diagnosis for cutaneous head and neck melanomas? Am J Otolaryngol. 2018;39(5):631-635. doi:10.1016/j.amjoto.2018.06.007

Garbe C, Amaral T, Peris K, et al. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment – Update 2024. Eur J Cancer. 2025;215:115153. doi:10.1016/j.ejca.2024.115153

Gillgren P, Drzewiecki KT, Niin M, et al. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial. The Lancet. 2011;378(9803):1635-1642. doi:10.1016/S0140-6736(11)61546-8

Utjés D, Malmstedt J, Teras J, et al. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: long-term follow-up of a multicentre, randomised trial. The Lancet. 2019;394(10197):471-477. doi:10.1016/S0140-6736(19)31132-8

Thomas JM, Newton-Bishop J, A’Hern R, et al. Excision Margins in High-Risk Malignant Melanoma. New England Journal of Medicine. 2004;350(8):757-766. doi:10.1056/NEJMoa030681

Gannon CJ, Rousseau DL, Ross MI, et al. Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma. Cancer. 2006;107(11):2647-2652. doi:10.1002/cncr.22320

Le ELH, Lamping E, Helmkamp L, et al. Analysis of Time Between Skin Lesion and Lymph Node Biopsies and Lymph Node Metastasis in Patients With Melanoma. JAMA Netw Open. 2023;6(5):e2311472. doi:10.1001/jamanetworkopen.2023.11472

Wong SL, Faries MB, Kennedy EB, et al. Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology. 2018;36(4):399-413. doi:10.1200/JCO.2017.75.7724

Moncrieff M, Pywell S, Snelling A, et al. Effectiveness of SPECT/CT Imaging for Sentinel Node Biopsy Staging of Primary Cutaneous Melanoma and Patient Outcomes. Ann Surg Oncol. 2022;29(2):767-775. doi:10.1245/s10434-021-10911-4

Bluemel C, Herrmann K, Giammarile F, et al. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging. 2015;42(11):1750-1766. doi:10.1007/s00259-015-3135-1

Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. New England Journal of Medicine. 2017;376(23):2211-2222. doi:10.1056/NEJMoa1613210

Leiter U, Stadler R, Mauch C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016;17(6):757-767. doi:10.1016/S1470-2045(16)00141-8

Leiter U, Stadler R, Mauch C, et al. Final Analysis of DeCOG-SLT Trial: No Survival Benefit for Complete Lymph Node Dissection in Patients With Melanoma With Positive Sentinel Node. Journal of Clinical Oncology. 2019;37(32):3000-3008. doi:10.1200/JCO.18.02306

Luke JJ, Ascierto PA, Khattak MA, et al. Pembrolizumab Versus Placebo as Adjuvant Therapy in Resected Stage IIB or IIC Melanoma: Final Analysis of Distant Metastasis-Free Survival in the Phase III KEYNOTE-716 Study. Journal of Clinical Oncology. 2024;42(14):1619-1624. doi:10.1200/JCO.23.02355

Kirkwood JM, Del Vecchio M, Weber J, et al. Adjuvant nivolumab in resected stage IIB/C melanoma: primary results from the randomized, phase 3 CheckMate 76K trial. Nat Med. 2023;29(11):2835-2843. doi:10.1038/s41591-023-02583-2

Eggermont AMM, Blank CU, Mandala M, et al. Longer Follow-Up Confirms Recurrence-Free Survival Benefit of Adjuvant Pembrolizumab in High-Risk Stage III Melanoma: Updated Results From the EORTC 1325-MG/KEYNOTE-054 Trial. Journal of Clinical Oncology. 2020;38(33):3925-3936. doi:10.1200/JCO.20.02110

Weber J, Mandala M, Del Vecchio M, et al. Adjuvant Nivolumab versus Ipilimumab in Resected Stage III or IV Melanoma. New England Journal of Medicine. 2017;377(19):1824-1835. doi:10.1056/NEJMoa1709030

Ascierto PA, Del Vecchio M, Mandalá M, et al. Adjuvant nivolumab versus ipilimumab in resected stage IIIB–C and stage IV melanoma (CheckMate 238): 4-year results from a multicentre, double-blind, randomised, controlled, phase 3 trial. Lancet Oncol. 2020;21(11):1465-1477. doi:10.1016/S1470-2045(20)30494-0

U.S. National Library of Medicine. ClinicalTrials.gov. Efficacy Study of Nivolumab Compared to Ipilimumab in Prevention of Recurrence of Melanoma After Complete Resection of Stage IIIb/c or Stage IV Melanoma (CheckMate 238) (NCT02388906). (29/08/2025 tarihinde https://clinicaltrials.gov/study/NCT02388906 adresinden erişilmiştir.

Long G V., Hauschild A, Santinami M, et al. Final Results for Adjuvant Dabrafenib plus Trametinib in Stage III Melanoma. New England Journal of Medicine. 2024;391(18):1709-1720. doi:10.1056/NEJMoa2404139

Long G V., Ascierto PA, Guo J, et al. Nivolumab plus relatlimab vs nivolumab alone for the adjuvant treatment of completely resected stage III–IV melanoma: Primary results from RELATIVITY-098. Journal of Clinical Oncology. 2025;43(17_suppl). doi:10.1200/JCO.2025.43.17_suppl.LBA9500

U.S. National Library of Medicine. ClinicalTrials.gov. A Study to Assess Adjuvant Immunotherapy With Nivolumab Plus Relatlimab Versus Nivolumab Alone After Complete Resection of Stage III–IV Melanoma (RELATIVITY-098) (NCT05002569). (29/08/2025 tarihinde https://clinicaltrials.gov/study/NCT05002569 adresinden erişilmiştir.

Seth R, Agarwala SS, Messersmith H, et al. Systemic Therapy for Melanoma: ASCO Guideline Update. Journal of Clinical Oncology. 2023;41(30):4794-4820. doi:10.1200/JCO.23.01136

Patel SP, Othus M, Chen Y, et al. Neoadjuvant–Adjuvant or Adjuvant-Only Pembrolizumab in Advanced Melanoma. New England Journal of Medicine. 2023;388(9):813-823. doi:10.1056/NEJMoa2211437

Blank CU, Lucas MW, Scolyer RA, et al. Neoadjuvant Nivolumab and Ipilimumab in Resectable Stage III Melanoma. New England Journal of Medicine. 2024;391(18):1696-1708. doi:10.1056/NEJMoa2402604

Reijers ILM, Menzies AM, Lopez-Yurda M, et al. Impact of personalized response-directed surgery and adjuvant therapy on survival after neoadjuvant immunotherapy in stage III melanoma: Comparison of 3-year data from PRADO and OpACIN-neo. Eur J Cancer. 2025;214:115141. doi:10.1016/j.ejca.2024.115141

Versluis JM, Menzies AM, Sikorska K, et al. Survival update of neoadjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma in the OpACIN and OpACIN-neo trials. Annals of Oncology. 2023;34(4):420-430. doi:10.1016/j.annonc.2023.01.004

Reijers ILM, Menzies AM, van Akkooi ACJ, et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med. 2022;28(6):1178-1188. doi:10.1038/s41591-022-01851-x

Menzies AM, Lo SN, Saw RPM, et al. Five-year analysis of neoadjuvant dabrafenib and trametinib for stage III melanoma. Annals of Oncology. 2024;35(8):739-746. doi:10.1016/j.annonc.2024.05.002

Long G V, Saw RPM, Lo S, et al. Neoadjuvant dabrafenib combined with trametinib for resectable, stage IIIB–C, BRAFV600 mutation-positive melanoma (NeoCombi): a single-arm, open-label, single-centre, phase 2 trial. Lancet Oncol. 2019;20(7):961-971. doi:10.1016/S1470-2045(19)30331-6

Amaria RN, Prieto PA, Tetzlaff MT, et al. Neoadjuvant plus adjuvant dabrafenib and trametinib versus standard of care in patients with high-risk, surgically resectable melanoma: a single-centre, open-label, randomised, phase 2 trial. Lancet Oncol. 2018;19(2):181-193. doi:10.1016/S1470-2045(18)30015-9

Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. Long-Term Outcomes With Nivolumab Plus Ipilimumab or Nivolumab Alone Versus Ipilimumab in Patients With Advanced Melanoma. Journal of Clinical Oncology. 2022;40(2):127-137. doi:10.1200/JCO.21.02229

Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. CheckMate 067: 6.5-year outcomes in patients (pts) with advanced melanoma. Journal of Clinical Oncology. 2021;39(15_suppl):9506-9506. doi:10.1200/JCO.2021.39.15_suppl.9506

Tawbi HA, Schadendorf D, Lipson EJ, et al. Relatlimab and Nivolumab versus Nivolumab in Untreated Advanced Melanoma. New England Journal of Medicine. 2022;386(1):24-34. doi:10.1056/NEJMoa2109970

Long GV SHFLESDAPMLSPCGERPGHLCJDMJDSAAGJKSSASADSTH. Overall Survival and Response with Nivolumab and Relatlimab in Advanced Melanoma. NEJM Evidence. 2023;2(5). doi:10.1056/EVIDx2300104

Tawbi HA, Hodi FS, Lipson EJ, et al. Three-Year Overall Survival With Nivolumab Plus Relatlimab in Advanced Melanoma From RELATIVITY-047. Journal of Clinical Oncology. 2025;43(13):1546-1552. doi:10.1200/JCO.24.01124

Dummer R, Flaherty KT, Robert C, et al. COLUMBUS 5-Year Update: A Randomized, Open-Label, Phase III Trial of Encorafenib Plus Binimetinib Versus Vemurafenib or Encorafenib in Patients With BRAF V600–Mutant Melanoma. Journal of Clinical Oncology. 2022;40(36):4178-4188. doi:10.1200/JCO.21.02659

Schadendorf D, Dummer R, Flaherty KT, et al. COLUMBUS 7-year update: A randomized, open-label, phase III trial of encorafenib plus binimetinib versus vemurafenib or encorafenib in patients with BRAF V600E/K-mutant melanoma. Eur J Cancer. 2024;204:114073. doi:10.1016/j.ejca.2024.114073

Ascierto PA, Casula M, Bulgarelli J, et al. Sequential immunotherapy and targeted therapy for metastatic BRAF V600 mutated melanoma: 4-year survival and biomarkers evaluation from the phase II SECOMBIT trial. Nat Commun. 2024;15(1):146. doi:10.1038/s41467-023-44475-6

Atkins MB, Lee SJ, Chmielowski B, et al. Combination Dabrafenib and Trametinib Versus Combination Nivolumab and Ipilimumab for Patients With Advanced BRAF -Mutant Melanoma: The DREAMseq Trial—ECOG-ACRIN EA6134. Journal of Clinical Oncology. 2023;41(2):186-197. doi:10.1200/JCO.22.01763

Ascierto PA, Mandalà M, Ferrucci PF, et al. Sequencing of Ipilimumab Plus Nivolumab and Encorafenib Plus Binimetinib for Untreated BRAF -Mutated Metastatic Melanoma (SECOMBIT): A Randomized, Three-Arm, Open-Label Phase II Trial. Journal of Clinical Oncology. 2023;41(2):212-221. doi:10.1200/JCO.21.02961

Davies MA, Saiag P, Robert C, et al. Dabrafenib plus trametinib in patients with BRAFV600-mutant melanoma brain metastases (COMBI-MB): a multicentre, multicohort, open-label, phase 2 trial. Lancet Oncol. 2017;18(7):863-873. doi:10.1016/S1470-2045(17)30429-1

Long G V, Atkinson V, Lo SN, et al. Ipilimumab plus nivolumab versus nivolumab alone in patients with melanoma brain metastases (ABC): 7-year follow-up of a multicentre, open-label, randomised, phase 2 study. Lancet Oncol. 2025;26(3):320-330. doi:10.1016/S1470-2045(24)00735-6

Tawbi HA, Forsyth PA, Hodi FS, et al. Long-term outcomes of patients with active melanoma brain metastases treated with combination nivolumab plus ipilimumab (CheckMate 204): final results of an open-label, multicentre, phase 2 study. Lancet Oncol. 2021;22(12):1692-1704. doi:10.1016/S1470-2045(21)00545-3

Carvajal RD. KIT as a Therapeutic Target in Metastatic Melanoma. JAMA. 2011;305(22):2327. doi:10.1001/jama.2011.746

Hodi FS, Corless CL, Giobbie-Hurder A, et al. Imatinib for Melanomas Harboring Mutationally Activated or Amplified KIT Arising on Mucosal, Acral, and Chronically Sun-Damaged Skin. Journal of Clinical Oncology. 2013;31(26):3182-3190. doi:10.1200/JCO.2012.47.7836

U.S. Food and Drug Administration (FDA). FDA grants accelerated approval to lifileucel for unresectable or metastatic melanoma. (16/02/2024; 29/08/2025 tarihinde https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-lifileucel-unresectable-or-metastatic-melanoma adresinden erişilmiştir).

Priantti JN, Vilbert M, Madeira T, et al. Efficacy and Safety of Rechallenge with BRAF/MEK Inhibitors in Advanced Melanoma Patients: A Systematic Review and Meta-Analysis. Cancers (Basel). 2023;15(15):3754. doi:10.3390/cancers15153754

Lens M, Schachter J. Immune Checkpoint Inhibitors in the Treatment of Advanced Melanoma in Older Patients: An Overview of Published Data. Cancers (Basel). 2025;17(11):1835. doi:10.3390/cancers17111835

Pelczar P, Kosteczko P, Wieczorek E, Kwieciński M, Kozłowska A, Gil-Kulik P. Melanoma in Pregnancy—Diagnosis, Treatment, and Consequences for Fetal Development and the Maintenance of Pregnancy. Cancers (Basel). 2024;16(12):2173. doi:10.3390/cancers16122173

Pandit-Taskar N, Dauer LT, Montgomery L, St Germain J, Zanzonico PB, Divgi CR. Organ and fetal absorbed dose estimates from 99mTc-sulfur colloid lymphoscintigraphy and sentinel node localization in breast cancer patients. J Nucl Med. 2006;47(7):1202-1208.

Portuguese AJ, Tykodi SS, Blosser CD, Gooley TA, Thompson JA, Hall ET. Immune Checkpoint Inhibitor Use in Solid Organ Transplant Recipients: A Systematic Review. Journal of the National Comprehensive Cancer Network. 2022;20(4):406-416.e11. doi:10.6004/jnccn.2022.7009

Remon J, Auclin E, Zubiri L, et al. Immune checkpoint blockers in solid organ transplant recipients and cancer: the INNOVATED cohort. ESMO Open. 2024;9(5):103004. doi:10.1016/j.esmoop.2024.103004

Barbir EB, Abdulmoneim S, Dudek AZ, Kukla A. Immune Checkpoint Inhibitor Therapy for Kidney Transplant Recipients – A Review of Potential Complications and Management Strategies. Transplant International. 2024;37. doi:10.3389/ti.2024.13322

Eroglu Z, Zaretsky JM, Hu-Lieskovan S, et al. High response rate to PD-1 blockade in desmoplastic melanomas. Nature. 2018;553(7688):347-350. doi:10.1038/nature25187

Garbe C, Amaral T, Peris K, et al. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics - Update 2024. Eur J Cancer. 2025;215:115152. doi:10.1016/j.ejca.2024.115152

Vetto JT. Clinical and Imaging Follow-Up for High-Risk Cutaneous Melanoma: Current Evidence and Guidelines. Cancers (Basel). 2024;16(14):2572. doi:10.3390/cancers16142572

Dieng M, Lord SJ, Turner RM, et al. The Impact of Surveillance Imaging Frequency on the Detection of Distant Disease for Patients with Resected Stage III Melanoma. Ann Surg Oncol. 2022;29(5):2871-2881. doi:10.1245/s10434-021-11231-3

U.S. Food and Drug Administration (FDA). Sunscreen: How to Help Protect Your Skin from the Sun. (16/08/2024; 28/08/2025 tarihinde https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun adresinden erişilmiştir).

American Academy of Dermatology Association. How to apply sunscreen. (28/08/2025 tarihinde https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-apply-sunscreen adresinden erişilmiştir).

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