2019
DOI: 10.3747/co.26.4885
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Primary Excision Margins, Sentinel Lymph Node Biopsy, and Completion Lymph Node Dissection in Cutaneous MelanomA: A Clinical Practice Guideline

Abstract: Background  For patients who are diagnosed with early-stage cutaneous melanoma, the principal therapy is wide surgical excision of the primary tumour and assessment of lymph nodes. The purpose of the present guideline was to update the 2010 Cancer Care Ontario guideline on wide local excision margins and sentinel lymph node biopsy (SLNB), including treatment of the positive sentinel node, for melanomas of the trunk, extremities, and head and neck.Methods  Using Ovid, the MEDLINE and EMBASE electronic databases… Show more

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Cited by 38 publications
(30 citation statements)
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“…The principles of a complete surgical resection are well defined, as resection margins should be appropriate in order to avoid and also decrease the risk of local recurrence. The conclusions of several randomized clinical trials helped define a consensus regarding the appropriate surgical margins according to the stage of the tumor [24,[34][35][36]. Moreover, a hypothesis was raised whether to perform a sentinel lymph node biopsy (SLNB) or complete lymph node dissection (CLND) to avoid a higher risk of developing in-transit metastasis.…”
Section: Discussionmentioning
confidence: 99%
“…The principles of a complete surgical resection are well defined, as resection margins should be appropriate in order to avoid and also decrease the risk of local recurrence. The conclusions of several randomized clinical trials helped define a consensus regarding the appropriate surgical margins according to the stage of the tumor [24,[34][35][36]. Moreover, a hypothesis was raised whether to perform a sentinel lymph node biopsy (SLNB) or complete lymph node dissection (CLND) to avoid a higher risk of developing in-transit metastasis.…”
Section: Discussionmentioning
confidence: 99%
“…3 ) with the goal of obtaining complete histologic clearance and thereby minimizing the risk of local recurrence (Table 1 ). However, the most recent guidelines from the USA [ 7 , 8 ], Australia [ 9 ], and Canada [ 10 ] recommend clinical margins of 5–10 mm for MIS. These guidelines recognize the high incidence of subclinical extension of MIS [ 11 ], especially LM, and suggest that these lesions often require clinical clearance margins greater than 5 mm to achieve histologically clear margins.…”
Section: Introductionmentioning
confidence: 99%
“…Minimum clearances from all margins should be stated/assessed. Consideration should be given to further excision if necessary; positive histological margins are unacceptable Level 4 (case series, poor quality cohort and case–control studies) Cancer Care Ontario [ 10 ] Canada 2019 Margin; 5–10 mm Not stated European Society for Medical Oncology (ESMO) [ 52 ] Europe 2019 Margin; 5 mm All margins; level II (RCT), grade B (strong or moderate evidence generally recommended) Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF [ 53 ] Germany 2019 A complete excision with histopathological control should be performed Consensus 88% Italian Association of Medical Oncologists [ 54 ] Italy 2019 Margin; 5 mm Low Regional Cancer Centre [ 55 ] Sweden 2019 Margin; about 5 mm Not stated American Academy of Dermatology [ 8 ] USA 2019 Margin; 5–10 mm Lower level (not further explained) National Comprehensive Cancer Network (NCCN) [ 7 ] USA 2019 Margin; 5–10 mm Level 2B (lower level evidence, NCCN consensus) European CanCer Organisation (ECCO) [ 56 ] Europe 2018 Margin; 5 mm Not stated Finnish Melanoma Group [ 57 ] Finland …”
Section: Introductionmentioning
confidence: 99%
“…Melanoma represents only 3% of the skin cancers diagnosed each year; however, the disease is accountable for approximately 65% of skin cancer-related deaths [1]. Standard management for patients with clinically node-negative melanoma includes evaluation of regional lymph nodes by means of a sentinel lymph node (SLN) biopsy [2]. SLN biopsy is classically performed using a blue dye (isosulfan or patent blue) and a radioactive tracer (Technetium ) in order to identify the first lymph node or nodes that drain the primary melanoma site [2].…”
Section: Introductionmentioning
confidence: 99%
“…Standard management for patients with clinically node-negative melanoma includes evaluation of regional lymph nodes by means of a sentinel lymph node (SLN) biopsy [ 2 ]. SLN biopsy is classically performed using a blue dye (isosulfan or patent blue) and a radioactive tracer (Technetium [Tc-99]) in order to identify the first lymph node or nodes that drain the primary melanoma site [ 2 ]. Despite advances in medical technology, pathologic analysis, and surgical techniques, false-negative SLN biopsy is still reported to occur in 13% of cases [ 3 ].…”
Section: Introductionmentioning
confidence: 99%