Home > Journals > Italian Journal of Dermatology and Venereology > Past Issues > Italian Journal of Dermatology and Venereology 2021 June;156(3) > Italian Journal of Dermatology and Venereology 2021 June;156(3):331-43

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as
Share

 

REVIEW  MELANOMA DIAGNOSIS AND MANAGEMENT Freefree

Italian Journal of Dermatology and Venereology 2021 June;156(3):331-43

DOI: 10.23736/S2784-8671.20.06776-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Surgical procedures in melanoma: recommended deep and lateral margins, indications for sentinel lymph node biopsy, and complete lymph node dissection

Eduardo NAGORE 1 , Ruggero MORO 2, 3

1 Department of Dermatology, Instituto Valenciano de Oncología (IVO), Valencia, Spain; 2 Graduate School, Valencia Catholic University Saint Vincent Martyr, Valencia, Spain; 3 Department of Dermatology, San Carlo Clinic, Paderno Dugnano, Milan, Italy



Surgery is the main treatment for cutaneous melanoma including the primary melanoma as well as lymph node metastases. The recommended margins have changed over time. Similarly, indications for sentinel lymph node biopsy and complete lymph node dissection are constantly evolving if knowledge on the biological behavior of melanomas increases. The current guidelines and the most relevant literature were reviewed to provide an update on the existing recommendations for surgical management of melanoma. Wide excision margins are evidenced-based but not for all situations. Melanoma in situ requires 0.5-1 cm with increasing evidence for 1 cm particularly those presenting on the head-and-neck in the setting of chronic sun damage. Invasive melanomas need 1-2 cm margins, 2 cm for tumors thicker than 2 mm and some large tumors with >1-2 mm thickness and with a lentiginous growth pattern. Lentigo maligna, subungual melanoma, and acral lentiginous melanoma require surgical techniques with complete circumferential peripheral margin assessment. Sentinel lymph node biopsy provides relevant information for melanoma staging. Therefore, it is consistently recommended for melanomas >1-4 mm and highly recommended for melanomas >4 mm, >0.8-1.0 mm or ≤0.8 mm with additional risk factors. Complete lymph node dissection has high morbidity and no impact on survival and is restricted to regional control for clinically detected metastasis. Although the trend is to reduce progressively the recommended surgical margins, further evidence is needed to clarify its role in patients’ survival. Sentinel lymph node biopsy is important for establishing a prognosis especially upon considering adjuvant therapy; complete lymph node dissection is only relevant for regional disease control.


KEY WORDS: Melanoma; Surgical procedures, operatives; Margins of excision; Sentinel lymph node; Lymph node excision

top of page