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Melanoma Treatment
Surgical Intervention
- Surgical excision with histologically negative margins is the primary treatment for cutaneous melanoma of any thickness, and in melanoma in situ
- 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 and reduce chance of recurrence
- Several international studies showed no significant difference in survival between narrow and wide margins thus permitting narrow surgical margins to be recommended due to its lesser morbidity rate
- Recommended surgical margins:
- In situ lesions: 0.5-1 cm
- Invasive melanoma: 1-2 cm
- Tumors ≤1 mm: 1 cm
- Tumors >1-2 mm thick: 1-2 cm
- Tumors >2 mm thick: 2 cm
- Lentigo maligna lesions: >0.5 cm due to wide subclinical extension
- For acral and facial melanoma, reduced safety margins may be considered if to preserve function of involved organs
- Permanent paraffin sections and not frozen sections are deemed to be the gold standard for surgical margins’ histologic evaluation for in situ and invasive lesions
- Surgical removal is also indicated for treatment of lymph node metastases (complete lymph node dissection) and 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 within 3-6 weeks after biopsy
