REVIEWS  CUTANEOUS MALIGNANCY UPDATE: MELANOMA IN 2007 

Giornale Italiano di Dermatologia e Venereologia 2007 April;142(2):171-95

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: English

The surgical management of cutaneous melanoma

Riker A. I. ¹, D’Alessio M. J. ¹, Hagmaier R. M. ¹, Glass L. F. ², Wayne Cruse C. ³

¹ Mitchell Cancer Institute Cutaneous Oncology Program University of South Alabama, USA 2 Division of Dermatology, University of South Florida, USA 3 Division of Plastic Surgery, USA

Melanoma is an enigmatic cancer that can be deadly in any and all of its forms if left unchecked or undiscovered. The incidence of melanoma is rapidly increasing over the last decade, the reasoning being multi-factorial combined with several known risk factors within the environment as well as personal behaviors. Although often overlooked in terms of importance, it cannot be stressed enough that we will have the most impact upon overall survival if we re-focus our efforts on the early detection and prevention of melanoma. Once melanoma has spread to the lymphatic system or hematogenously, the overall survival of all patients dramatically decreases in comparison to the outstanding survival of those patients who undergo the appropriate margins of excision for melanoma in situ. Indeed, the surgical management of melanoma has changed dramatically within the last 20 years. We have been guided by the results of well-designed prospective, randomized trials addressing the optimal surgical margins of excision of the primary melanoma, able to modify and refine the way that we surgically manage such patients. Further studies have definitively addressed the efficacy of the elective lymph node dissection, with recent studies showing the central role of selective lymphadenectomy in the management of the draining lymph node basin(s). We will discuss all of these issues and more, providing evidence-based data to support (or refute) current surgical thought and decision making. Some issues still remain controversial due to a paucity of evidence-based data to support their use. Other on-going studies may further guide us in the surgical management of melanoma. Lastly, we will revisit the past surgical advances for melanoma and how we can learn from them. In turn, this will guide us as to how we will proceed and advance this field in the future