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Current Oncology
Volume 26
Issue 4
10.3747/co.26.4885
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

Primary Excision Margins, Sentinel Lymph Node Biopsy, and Completion Lymph Node Dissection in Cutaneous MelanomA: A Clinical Practice Guideline

by
F.C. Wright
1,*,
L.H. Souter
2,
S. Kellett
2,
A. Easson
3,
C. Murray
4,
J. Toye
5,
D. McCready
3,
C. Nessim
6,
D. Ghazarian
7,
N.J. Look Hong
8,
S. Johnson
6,
D.P. Goldstein
7,
T. Petrella
1 and
the Melanoma Disease Site Group
1
Odet te Regional Cancer Cent re, Toronto, ON, Canada
2
Program in Evidence-Based Care, Hamilton, ON, Canada
3
Princess Margaret Hospital, Toronto, ON, Canada
4
Women’s College Hospital, Toronto, ON, Canada
5
Royal Victoria Regional Health Centre, Barrie, ON, Canada
6
The Ottawa Hospital, Ottawa, ON, Canada
7
Toronto General Hospital, Toronto, ON, Canada
8
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2019, 26(4), 541-550; https://doi.org/10.3747/co.26.4885
Submission received: 2 May 2019 / Revised: 7 June 2019 / Accepted: 11 July 2019 / Published: 1 August 2019

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 were systematically searched for systematic reviews and primary literature evaluating narrow compared with wide excision margins and the use of slnb for melanoma of the truck and extremities and of the head and neck. Search timelines ran from 2010 through week 25 of 2017. Results: Four systematic reviews were chosen for inclusion in the evidence base. Where systematic reviews were available, the search of the primary literature was conducted starting from the end date of the search in the reviews. Where systematic reviews were absent, the search for primary literature ran from 2010 forward. Of 1213 primary studies identified, 8 met the inclusion criteria. Two randomized controlled trials were used to inform the recommendation on completion lymph node dissection. Key updated recommendations include: (1) Wide local excision margins should be 2 cm for melanomas of the trunk, extremities, and head and neck that exceed 2 mm in depth. (2) SLNB should be offered to patients with melanomas of the trunk, extremities, and head and neck that exceed 0.8 mm in depth. (3) Patients with sentinel node metastasis should be considered for nodal observation with ultrasonography rather than for completion lymph node dissection. Conclusions: Recommendations for primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in patients with cutaneous melanoma have been updated based on the current literature.
Keywords: melanoma; sentinel lymph nodes; sentinel lymph node metastases; wide excision margins; practice guidelines; melanoma in situ; margins; completion lymph node dissection melanoma; sentinel lymph nodes; sentinel lymph node metastases; wide excision margins; practice guidelines; melanoma in situ; margins; completion lymph node dissection

Share and Cite

MDPI and ACS Style

Wright, F.C.; Souter, L.H.; Kellett, S.; Easson, A.; Murray, C.; Toye, J.; McCready, D.; Nessim, C.; Ghazarian, D.; Hong, N.J.L.; et al. Primary Excision Margins, Sentinel Lymph Node Biopsy, and Completion Lymph Node Dissection in Cutaneous MelanomA: A Clinical Practice Guideline. Curr. Oncol. 2019, 26, 541-550. https://doi.org/10.3747/co.26.4885

AMA Style

Wright FC, Souter LH, Kellett S, Easson A, Murray C, Toye J, McCready D, Nessim C, Ghazarian D, Hong NJL, et al. Primary Excision Margins, Sentinel Lymph Node Biopsy, and Completion Lymph Node Dissection in Cutaneous MelanomA: A Clinical Practice Guideline. Current Oncology. 2019; 26(4):541-550. https://doi.org/10.3747/co.26.4885

Chicago/Turabian Style

Wright, F.C., L.H. Souter, S. Kellett, A. Easson, C. Murray, J. Toye, D. McCready, C. Nessim, D. Ghazarian, N.J. Look Hong, and et al. 2019. "Primary Excision Margins, Sentinel Lymph Node Biopsy, and Completion Lymph Node Dissection in Cutaneous MelanomA: A Clinical Practice Guideline" Current Oncology 26, no. 4: 541-550. https://doi.org/10.3747/co.26.4885

APA Style

Wright, F. C., Souter, L. H., Kellett, S., Easson, A., Murray, C., Toye, J., McCready, D., Nessim, C., Ghazarian, D., Hong, N. J. L., Johnson, S., Goldstein, D. P., Petrella, T., & the Melanoma Disease Site Group. (2019). Primary Excision Margins, Sentinel Lymph Node Biopsy, and Completion Lymph Node Dissection in Cutaneous MelanomA: A Clinical Practice Guideline. Current Oncology, 26(4), 541-550. https://doi.org/10.3747/co.26.4885

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