Optimal Resection Margin for Cutaneous Malignant Melanoma

De, Elder; th, Guerry D; Heiberger, Richard M.; LaRossa, Donato; Li, Goldman; Wh, Clark; Cj, Thompson; Matozzo, Isabel; M, Van Horn

doi:10.1097/00006534-198301000-00015

Cited by 100 publications

(27 citation statements)

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“…Over the next several decades, clinical anecdotes and several retrospective studies suggested that narrower excision margins may be appropriate treatment for selected patients [6][7][8][9][10]. A gradual evolution away from very radical excisions accompanied the understanding that outcome of survival and local recurrence were related more to the intrinsic biology of the primary tumor than to the width of excision.…”

Section: Opinion Statementmentioning

confidence: 99%

Primary cutaneous melanoma: surgical management and other treatment options

Wagner

Bergman²

2003

Curr. Treat. Options in Oncol.

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The incidence of primary cutaneous melanoma continues to increase and is a growing public health problem. By virtue of its metastatic potential, melanoma accounts for most of the deaths from cutaneous malignancies. Management of cutaneous melanoma has undergone a paradigm shift in recent years. Clinical studies have furthered our understanding of the biology of this disease and have changed the standards of care. Specifically, sentinel node biopsy and interferon as the first effective postsurgical therapy have had a significant impact on the treatment of patients with melanoma. Surgery remains the primary treatment modality for cutaneous melanoma. An adequate excision of the primary lesion accomplishes durable local control and is curative for patients without micrometastatic disease. Although the extent of surgical resection has decreased in recent years, the standard treatment for primary cutaneous melanoma remains wide surgical excision with histologically negative margins. The extent of excision is based on the theory that the incidence and radial extent of local recurrences can be predicted by specific primary tumor histopathologic characteristics. Tumor thickness and ulceration are the most important histologic features associated with prognosis and are the basis for the current recommendations for surgical treatment of the primary tumor. The extent of surgical therapy for primary melanoma is an area of ongoing debate. No clinical trial has shown a survival disadvantage for narrow versus wide excision regimens for melanoma of any thickness. Ongoing clinical trials will determine the relationship between the extent of surgical therapy for the primary tumor and the outcomes of recurrence and survival in patients with melanoma.

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Section: Opinion Statementmentioning

confidence: 99%

Primary cutaneous melanoma: surgical management and other treatment options

Wagner

Bergman²

2003

Curr. Treat. Options in Oncol.

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“…Until fairly recently, the surgical standard of care was a 3-to 5-cm WLE and a split-thickness skin graft. Increasingly, however, it has become evident that the risk of local recurrence coincides more with the thickness of the lesion than with the extent of the surgical margins [3][4][5][6][7]. Use of surgical margins that vary with the ulceration and thickness of the lesion may be a more rational approach, as these factors seem to correlate best with the risk for local recurrence [8].…”

Section: Wide Local Excisionmentioning

confidence: 99%

“…For "thin" melanomas (those less than 1 mm in thickness), only a minimal local recurrence rate has been reported in observed patient series [3,4,6,[11][12][13][14][15][16], despite varying surgical margins. In other words, survival is not influenced by the size of the resection margins.…”

Section: Wide Local Excisionmentioning

confidence: 99%

“…This does not mean that re-excision is unnecessary, but, rather, it indicates that a minimum margin size has not yet been established. Currently, a wide excision consisting of no less than a 1-cm minimum margin of skin is recommended by many melanoma surgeons [3,6,11,12,14,[17][18][19][20]. This procedure may be performed as a generous elliptical excision and a primary skin closure.…”

Section: Wide Local Excisionmentioning

confidence: 99%

“…The 15 patients who suffered a local recurrence had a rather poor survival rate of 28% at 5-year followup. The risk of local recurrence may exceed 10% to 20% for those melanomas over 4 mm in thickness [3,6,8,15,19].…”

Section: Wide Local Excisionmentioning

confidence: 99%

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Surgical management of primary melanoma

et al. 2000

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A significant proportion of the general population is diagnosed with malignant melanoma each year, and more people die of melanoma now than at any time in the past. Consequently, treatment of melanoma at all stages of development is an important clinical issue. A variety of management options are discussed here, including biopsy techniques and treatment of the primary melanoma. The latter include lymphatic mapping and sentinel lymph node biopsy, hyperthermic isolated limb perfusion, and surgery for stage IV melanoma patients. Procedure-associated benefits and possible complications associated with each modality are also summarized.

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A Factual, Not Arbitrary, Basis for Choice of Resection Margins in Melanoma

Piepkorn

Barnhill²

1996

Arch Dermatol

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Optimal Resection Margin for Cutaneous Malignant Melanoma

Cited by 100 publications

References 0 publications

Primary cutaneous melanoma: surgical management and other treatment options

Primary cutaneous melanoma: surgical management and other treatment options

Surgical management of primary melanoma

A Factual, Not Arbitrary, Basis for Choice of Resection Margins in Melanoma

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