Treatment Guideline Chart
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.

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
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