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Malignant melanoma. Primary surgical management (excision and node dissection) based on pathology and staging
M N Harris1, R L Shapiro, D F Roses
1Department of Surgery, New York University School of Medicine, New York, USA.
Cancer
|January 15, 1995
Summary
Accurate malignant melanoma diagnosis relies on clinical assessment and biopsy for staging. While lymph node dissection is debated, lymphatic mapping may identify patients who benefit from this procedure.
Area of Science:
- Dermatology
- Surgical Oncology
Background:
- Malignant melanoma diagnosis requires clinical evaluation and biopsy for accurate staging.
- Melanoma thickness, assessed by Clark and Breslow methods, guides treatment decisions, including surgical margins.
Purpose of the Study:
- To review the diagnostic and staging methods for malignant melanoma.
- To discuss the controversies and current understanding of lymph node dissection in melanoma management.
Main Methods:
- Review of clinical and pathological staging methods for melanoma.
- Analysis of existing literature on elective lymph node dissection and its impact on survival.
- Evaluation of intraoperative lymphatic mapping and selective lymphadenectomy.
Main Results:
- Biopsy, preferably excision, is crucial for assessing melanoma type and thickness (Clark/Breslow).
- Surgical margins should be conservative for thin lesions (<1.0 mm) and wider for thicker ones.
- Elective lymph node dissection is generally not recommended for thin melanomas (<1.0 mm) and may offer limited benefit for thick lesions (>4.0 mm).
Conclusions:
- The role of elective lymph node dissection in intermediate thickness melanomas remains controversial.
- Prospective trials suggest lymph node positivity indicates systemic disease, with similar survival outcomes for therapeutic lymph node dissection.
- Intraoperative lymphatic mapping and selective lymphadenectomy can help identify patients who may benefit from lymphadenectomy.