Melanoma surgery: Difference between revisions

	Melanoma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Melanoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Melanoma surgery On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Melanoma surgery All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Melanoma surgery
CDC on Melanoma surgery
Melanoma surgery in the news
Blogs on Melanoma surgery
Directions to Hospitals Treating Melanoma
Risk calculators and risk factors for Melanoma surgery

VisualWikitext

Latest revision as of 02:37, 27 November 2017

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

Overview

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

Surgical Margins for Wide Excision of Primary Melanoma

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

A blue stained sentinel axillary lymph node

Complete Lymph Node Dissection

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

References

↑ ^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.

[pmid23584343-1] 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.

[1]

@@ Line 1: / Line 1: @@
-{{CMG}}
+__NOTOC__
+{{CMG}} {{AE}} {{YD}}; {{SSK}}
 {{Melanoma}}
 ==Overview==
+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==
+===Surgical Margins for Wide Excision of Primary Melanoma===
+*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.<ref name="pmid23584343">{{cite journal| author=Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A et al.| title=Melanoma, version 2.2013: featured updates to the NCCN guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 4 | pages= 395-407 | pmid=23584343 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23584343  }} </ref>
+*The margins may be individualized to accomodate anatomic and functional considerations.<ref name="pmid23584343">{{cite journal| author=Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A et al.| title=Melanoma, version 2.2013: featured updates to the NCCN guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 4 | pages= 395-407 | pmid=23584343 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23584343  }} </ref>
-==Minor surgery==
+{| {{table}}
-Moles that are irregular in color or shape are suspicious of a malignant or a premalignant melanoma. Following a visual examination and a [[Dermatoscopy|dermatoscopic exam]] (an instrument that illuminates a mole, revealing its underlying pigment and vascular network structure), the doctor may biopsy the suspicious mole.  If it is malignant, the mole and an area around it needs excision. This will require a referral to a surgeon or dermatologist.
+| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Tumor thickness'''}}
+| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''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
+|}
-The diagnosis of melanoma requires experience, as early stages may look identical to harmless [[Mole (skin marking)|moles]] or not have any color at all. Where any doubt exists, the patient will be referred to a specialist dermatologist. Beyond this expert knowledge a [[biopsy]] performed under [[local anesthesia]] is often required to assist in making or confirming the [[diagnosis]] and in defining the severity of the melanoma.
+[[Image:Sentinel lymph node (axilla).jpg|thumb|370px|A blue stained sentinel axillary lymph node]]
+===Complete Lymph Node Dissection===
-''Excisional biopsy'' is the management of choice; this is where the suspect lesion is totally removed with an adequate ellipse of surrounding skin and tissue.<ref>{{cite journal | author = Swanson N, Lee K, Gorman A, Lee H | title = Biopsy techniques. Diagnosis of melanoma. | journal = Dermatol Clin | volume = 20 | issue = 4 | pages = 677-80 | year = 2002 | id = PMID 12380054}}</ref> The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin, enabling the [[pathology|histopathologist]] to determine the depth of penetration of the melanoma by microscopic examination.  This is described by Clark's level (involvement of skin structures) and [[Breslow's depth]] (measured in millimeters).
+The 2013 National Comprehensive Cancer Network (NCCN) recommends complete dissection of involved nodal basin is recommended.<ref name="pmid23584343">{{cite journal| author=Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A et al.| title=Melanoma, version 2.2013: featured updates to the NCCN guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 4 | pages= 395-407 | pmid=23584343 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23584343  }} </ref>
+*Specific considerations for the groin lymph nodes
-[[Image:Malignant melanoma (1) at thigh Case 01.jpg|100px|Malignant melanoma in skin biopsy with [[Hematoxylin|H]] and [[eosin|E]] stain.]]
+:*Indications for iliac and obturator lymph node dissection:
-[[Image:Malignant melanoma (2) at thigh Case 01.jpg|100px|This case may represent superficial spreading melanoma.]]
+::*Positive pelvic CT, or
-[[Image:Malignant melanoma (3) at thigh Case 01.jpg|100px|The same case as the last one.]]
+::*Cloquet's node is positive
-[[Image:Malignant melanoma (4) at thigh Case 01.jpg|100px|Enlargement of the image.]]
+:*Elective iliac and obturator lymph node dissection
+::*Clinically positive superficial node, or
-If an excisional biopsy is not possible in certain larger pigmented lesions, a ''punch biopsy'' may be performed by a specialist hospital doctor, using a surgical punch (an instrument similar to a tiny cookie cutter with a handle, with an opening ranging in size from 1 to 6&nbsp;mm).  The punch is used to remove a plug of skin (down to the subcutaneous layer) from a portion of a large suspicious lesion, for histopathological examination.
+::*≥ 3 superficial nodes are positive
 ==References==
 {{Reflist|2}}
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Dermatology]]
+[[Category:Surgery]]