Melanoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Yazan Daaboul, M.D.; Serge Korjian M.D. Anum Ijaz M.B.B.S., M.D.[2]

Melanoma Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Melanoma from other Diseases

Epidemiology and Demographics

Risk Factors

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Diagnosis

Diagnostic Study of Choice

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Cost-Effectiveness of Therapy

Future or Investigational Therapies

2019 AAD Guidelines for management of Primary Cutaneous Melanoma (CM)

Guidelines for Diagnosis of Primary CM

Guidelines for Treatment of Primary CM

Guidelines for management of Primary CM in Pregnancy

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Case #1

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## Overview[edit | edit source]

The predominant treatment for primary melanoma is wide excision of the lesion margins. The choice of clinical margins is based on the tumor thickness. When lymph nodes are involved, complete dissection of the nodal basin is recommended.

## Surgery[edit | edit source]

### Surgical Margins for Wide Excision of Primary Melanoma[edit | edit source]

* The National Comprehensive Cancer Network (NCCN) recommends wide excision of margins of primary melanoma.
* The choice of clinical margins is based on the tumor thickness.[1]
* The margins may be individualized to accomodate anatomic and functional considerations.[1]

Tumor thickness | Recommended Clinical Margins

|

In situ | 0.5 cm
≤ 1 mm | 1 cm
> 1 mm - 2 mm | 1-2 cm
> 2 mm - 4 mm | 2 cm
> 4 mm | 2 cm

To view 2019 AAD Guidelines for Surgical Treatment of Primary Cutaneous Melanoma, click here

A blue stained sentinel axillary lymph node

### Complete Lymph Node Dissection[edit | edit source]

The 2013 National Comprehensive Cancer Network (NCCN) recommends complete dissection of involved nodal basin is recommended.[1]

* Specific considerations for the groin lymph nodes

* Indications for iliac and obturator lymph node dissection:

* Positive pelvic CT, or
* Cloquet's node is positive

* Elective iliac and obturator lymph node dissection

* Clinically positive superficial node, or
* ≥ 3 superficial nodes are positive

To view 2019 AAD Guidelines for Sentinal Lymph Node Biopsy, click here

## References[edit | edit source]

1. ↑ 1.0 1.1 1.2 Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A; et al. (2013). "Melanoma, version 2.2013: featured updates to the NCCN guidelines". J Natl Compr Canc Netw. 11 (4): 395–407. PMID 23584343.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)