How is stage II of melanoma treated?

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

Answer

Perform a 2-cm surgical resection on stage II lesions. No recurrence or survival advantage is gained when 2-cm margins are compared with wider margins (4-6 cm), as has been confirmed in a 2011 European study. [24] Smaller resection decreases the need for skin grafting and inpatient hospital stay. [25]

Perform a complete therapeutic lymphadenectomy on patients with suspected lymph node metastases based on physical examination findings. This consists of excision of all lymph nodes in the affected regional lymph node basin.

Consider sentinel lymph node biopsy if no clinically positive nodes are present. With the use of blue dye, radioisotope, or both, injected at the site of the primary melanoma, the first-echelon node can be identified within the regional lymph node basin. Send this sentinel node to the pathologist for analysis using routine stains, immunohistochemistry, and even polymerase chain reaction in some centers. If the sentinel node is positive, then regional lymph node metastases is probable; importantly, perform a complete lymph node dissection. The correlation is based on the thickness of the primary tumor. If the sentinel lymph node is negative, the chance is 99% that all others are negative. This procedure is becoming the standard of care for tumors greater than 1 mm in depth.

Hyperthermic arterial limb perfusion with melphalan for extremity melanomas has been studied as an adjuvant therapy. One study found it to be beneficial in that it produced higher response rates and overall survival rates than those for surgery alone. Other studies do not demonstrate benefit.

Adjuvant chemotherapy and/or biological therapy are also undergoing clinical evaluation. One study demonstrated that high-dose interferon alfa-2b resulted in prolonged relapse-free survival and overall survival compared with no adjuvant therapy. A follow-up study by the same group demonstrated preliminary results indicating high-dose interferon achieved a relapse-free survival benefit over no adjuvant treatment but not over low-dose interferon. Neither high- nor low-dose interferon had a significant overall survival advantage compared with observation alone. High-dose interferon can be associated with significant toxic/adverse effects (ie, liver toxicity), and some patients require dose reduction because it may not be well tolerated.


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