Healthcare 2014, 2(2), 234-249; doi:10.3390/healthcare2020234

Update and Review on the Surgical Management of Primary Cutaneous Melanoma

1email, 1,†email, 1,†email, 1email, 2email and 1,* email
Received: 19 November 2013; in revised form: 17 April 2014 / Accepted: 6 May 2014 / Published: 10 June 2014
(This article belongs to the Special Issue Melanoma and Neoplasms of Skin)
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract: The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization’s 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1–2 cm for melanoma thickness of 1.01–2 mm, 2 cm margins for melanoma thickness of 2.01–4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm2) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits.
Keywords: primary cutaneous melanoma; melanoma; surgical management of melanoma; surgical margins of melanoma; sentinel lymph node biopsy in melanoma; lymphadenectomy in melanoma
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MDPI and ACS Style

Leilabadi, S.N.; Chen, A.; Tsai, S.; Soundararajan, V.; Silberman, H.; Wong, A.K. Update and Review on the Surgical Management of Primary Cutaneous Melanoma. Healthcare 2014, 2, 234-249.

AMA Style

Leilabadi SN, Chen A, Tsai S, Soundararajan V, Silberman H, Wong AK. Update and Review on the Surgical Management of Primary Cutaneous Melanoma. Healthcare. 2014; 2(2):234-249.

Chicago/Turabian Style

Leilabadi, Solmaz N.; Chen, Amie; Tsai, Stacy; Soundararajan, Vinaya; Silberman, Howard; Wong, Alex K. 2014. "Update and Review on the Surgical Management of Primary Cutaneous Melanoma." Healthcare 2, no. 2: 234-249.

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