Excision Margins for Primary Cutaneous Melanoma

Lens, Marko; Nathan, Paul; Bataille, Véronique

doi:10.1001/archsurg.142.9.885

Cited by 73 publications

(10 citation statements)

References 22 publications

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“…Besides SNB status, which seems to be a strong prognostic factor in all studies, several other possible prognostic factors for recurrence and survival of patients with a thick melanoma have been reported. A supposed favorable impact of wide excision margins (3–5 cm) on prognosis has been invalidated previously for melanoma in general [20, 21] and thick melanomas as well [22]. Another large study found an impact of surgical margins on recurrence but not on survival in patients with a melanoma at least 2 mm thick [23].…”

Section: Discussionmentioning

confidence: 99%

Thick Melanoma: Prognostic Value of Positive Sentinel Nodes

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Thick Melanoma: Prognostic Value of Positive Sentinel Nodes

et al. 2009

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“…The primary goal of wide excision of malignant melanoma is to achieve a histologically negative margin and prevent local recurrence. Surgical margin recommendations are based on studies in which margins were clinically measured around the primary tumor and including these basic concepts: 1) Wide excision is associated with a reduced risk of local recurrence; 2) there is no evidence in thin melanoma (<1 mm) to confirm the improvement of the survival or local recurrence rate with excision margins exceeding 1 cm; 3) Excision with greater than 2-cm margins offers no benefit in the survival rate or local recurrence [22]. …”

Section: Treatmentmentioning

confidence: 99%

Management of Malignant Melanoma

Mun

2012

Arch Plast Surg

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IncidenceMalignant melanoma is the leading cause of death in skin cancers. The incidence of melanoma is reported to vary throughout the world. It demonstrates a clear demographic disparity, and is a common malignancy in Western countries. It is reported at the highest rates in Auckland, New Zealand, with the age-standardized rate of 40.2/100,000 [1]. Other high rates have been reported in Australia, with a rate of 37.7/100,000 among males and 29.4/100,000 among females [2]. In the United States, 68,720 patients diagnosed with and 8,650 deaths from malignant melanoma were reported in 2009 [3]. In Asia, malignant melanoma is a rare disease and it is difficult to locate reports on the incidence. The age-adjusted rate for melanoma in 2006 was known to be 0.65/100,000 and 0.71/100,000 for males and 0.59/100,000 for females in Taiwan. To the best of our knowledge, there has been no multi-center study of malignant melanoma in Korea. EtiologyUV exposure has been implicated as a major cause in the etiology of malignant melanoma [4]. However, acral lentiginous melanoma (ALM) and mucosal melanoma, which are more common in Asia, are generally not a result of exposure to ultraviolet irradiation. The etiology is yet to be determined. In an epidemiologic study of ALM from Australia, an increased risk was associated with penetrating injury of the feet or hands (relative CONtINUING MeDICAL eDUCAtION

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“…However, clear evidence is not available, and final surgical margins may vary based on tumour location and functional or cosmetic considerations [3-7]. ” …”

Section: Introductionmentioning

confidence: 99%

New Safety Margins for Melanoma Surgery: Nice Possibility for Drinking of "Just That Cup of Coffee"?

Tchernev¹,

Chokoeva²

2017

Open Access Maced J Med Sci

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BACKGROUND:The American Joint Committee on Cancer (AJCC’s) skin melanoma surgical treatment recommendations from 2011 are characterised by a prima facie “freedom of choice” regarding how extensive should be the excisions for melanomas with tumour thickness up to 2 mm and melanoma in situ. It is unclear why the recommended surgical security margins vary between 0.5 and 1 cm for melanoma in situ, whereas for melanomas with a tumour thickness of up to 1.99 mm, the range of variation is also between 1 and 2 cm, without specifying when the surgical field should be broader and, narrower, accordingly. This “uncertainty or lack of intent” of the guilders often leads to the same surgical approach to melanomas at different stages, or to a different approach in cases of melanomas at the same stage, in contrast. Therefore, this should be defined as wrong, logically.CASE PRESENTATION:We present 3 patients with cutaneous melanomas, treated with similar fields of surgical security. Current issues, generated within the framework of melanoma’s surgery guided by the recommendations of the AJCC are also discussed. A new surgical approach in patients with melanoma is recommended, discussed for the first time in world literature. We hypothesize that the introduction of a certain recommendations for a 2 cm surgical field in all directions during the initial excision, combined with the parallel performance of a sentinel lymph node biopsy, will lead in fact to several important advantages: 1) avoiding of the secondary excision in at least 70% - 90% of the patients (depending on the tumor thickness), 2) minimizing the risk of lymphatic effusion change and misinterpretation of the sentinel lymph node biopsy’s results in patients with secondary excision; 3) optimization of the surgical team’s work; 4) minimizing the possibility of unprepared/uninformed personnel to take part in decisions for treating a specific disease such as skin melanoma, 4) facilitating the appropriate patients’ group selection at the appropriate stage when involving them in different studies, leading to equal leveling of the initial positions;CONCLUSION:Whether the proposed approach will be subjected to a detailed discussion of AJCC’s expert’s remains currently unclear.

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Excision Margins for Primary Cutaneous Melanoma

Cited by 73 publications

References 22 publications

Thick Melanoma: Prognostic Value of Positive Sentinel Nodes

Thick Melanoma: Prognostic Value of Positive Sentinel Nodes

Management of Malignant Melanoma

New Safety Margins for Melanoma Surgery: Nice Possibility for Drinking of "Just That Cup of Coffee"?

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