melanoma
MELANOMA
Melanoma is a skin neoplasm that originates from malignant transformation of melanocytes.
It commonly occurs in the extremities of women and on trunk or head and neck in men.
Metastases are via lymphatic and hematogenous routes.

Surgical Intervention

  • Surgical excision w/ histologically negative margins is the primary treatment for cutaneous melanoma of any thickness
    • Mainstay of curative treatment for primary melanoma
  • Surgical margins, as determined by the Breslow depth, ensure complete removal of the lesion to definitively treat it & reduce chance of recurrence
    • A Cochrane review in 2009 showed no significant difference in survival between narrow & wide margins thus permitting narrow surgical margins to be recommended due to its lesser morbidity rate
    • Surgical margins for in situ lesions are 0.5-1 cm, invasive melanoma 1-2 cm, 1 cm margin for tumors <1 mm, 1-2 cm margin for melanomas >1-2 mm thick, 2 cm for tumors w/ >2 mm thickness, & for lentigo maligna lesions >0.5 cm due to wide subclinical extension
    • Permanent paraffin sections & not frozen sections are deemed to be the gold standard for surgical margins’ histologic evaluation for in situ & invasive lesions
  • Surgical removal is also indicated for treatment of lymph node metastases (complete lymph node dissection) & distant metastatic spread to organs (if feasible) to achieve palliation
  • Though no literature is available for the optimal time from diagnosis to treatment, final operative management should be done w/in 3-6 wk after biopsy
Editor's Recommendations
Most Read Articles
Jairia Dela Cruz, 24 Jan 2017
The likelihood of developing atopic dermatitis and food sensitization may be low among children with habitual consumption of yogurt products in infancy, according to a recent study.
Gayle Fischer, 01 Jun 2014

Acute vulvovaginal candidiasis (VVC) is common and usually easily treated but some women develop chronic symptoms that do not respond to conventional anti-Candida treatment. Recently proposed diagnostic criteria may help clinicians identify women with chronic VVC. Evidence is mounting that it represents a hypersensitivity response to commensal Candida spp. It usually responds to long-term antifungal treatment.

01 Oct 2013

Bacterial vaginosis affects approximately 29% of women of childbearing age. The aetiology of the disorder is unclear, but it is characterized by an alteration in the vaginal microflora and the replacement of Lactobacillus spp with anaerobic vaginal bacteria such as Gardnerella vaginalis, Prevotella spp, Mobiluncus spp, Mycoplasma hominis, and Atopobium vaginae. The disorder can become chronic, but a recent study has shown that the application of vaginal ascorbic acid (vitamin C) tablets has a prophylactic effect.