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
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