What are the surgical options for melanoma?

Updated: Mar 08, 2019
  • Author: Jonathan B Heistein, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Answer

Answer

Surgical therapy for melanoma, as follows, is based on the predicted risk of local recurrence and metastatic disease and the potential morbidity of the operation:

  • Stage 0: Widely excise the tumor or previous biopsy site; use a 0.5- to 1-cm margin for melanomas in situ

  • Stage I: 1-cm excision margins are adequate, but lesions greater than 1 mm require 2-cm margins; for lesions with a depth greater than 1 mm, many authorities recommend sentinel lymph node biopsy at the time of wide local excision

  • Stage II: Perform a 2-cm surgical resection; carry out a complete therapeutic lymphadenectomy on patients with suspected lymph node metastases based on physical examination findings; consider sentinel lymph node biopsy if no clinically positive nodes are present

  • Stage III: Wide local excision of the primary tumor with 2-cm margins remains first-line therapy; [1] perform regional lymph node dissection because a stage III melanoma represents nodal disease; If the nodal status is unknown, consider a sentinel lymph node biopsy to determine if the disease is stage I, II, or III

  • Stage IV: Usually refractory to standard therapy; thus, consider these patients for clinical trials; surgical resection of isolated metastases in the gastrointestinal tract, the brain, the lungs, or bone may be performed for palliation; metastatic lymph nodes also may be removed for palliation; radiation may provide symptomatic relief for metastases to bone, the brain, or viscera


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