The Novel Surgical Margin for One Step Melanoma Surgery (OSMS) (Without Using Ultrasonography Preoperatively): The End of Conformity! ʺVivere militare est!ʺ

Abstract

BACKGROUND:Innovations in medicine are often due to the simplicity of a certain activity, interaction, even counteraction, or a mistake leading to a subsequent final optimal outcome. Innovations could also be due to conclusions based on targeted clinical or sporadic, as well as completely random observations. The genius of an approach or statement is often based on the “iron logic”, which in turn is based on irrefutable data or facts. These are often observations or results from actions that happen right before our eyes and provide advantages or prerequisites for the better future development of things (in this case, disease) concerning certain groups of people (in these case-patients). When the clinical results achieved following an inevitable introduction of certain methods or innovations speak eloquently of a number of advantages in terms of 1) spearing effect on the patients, 2) better control or prevention of possible local and/or distant metastatic spread 3) better financial balance for the health institutions and patients, …, then even the “Gods of certain latitudes” should be silenced. We at this moment present a completely new method or approach for surgical treatment of cutaneous melanoma that once again proves the effectiveness of one-step melanoma surgery, which was successfully first officialised in the world literature again by the Bulgarian Society of Dermatologic Surgery, (BULSDS). In some cases, this method does not even require the preoperative use of a high-frequency ultrasound for determining the tumour thickness.CASE REPORT:In patients with advanced stage of cutaneous melanoma, removal of a primary draining lymph node and/or locoregional lymph nodes is often performed simultaneously. However, it remains unclear why in patients with early-stage (or intermediate, with moderately thick melanomas) disease high-frequency ultrasound is not applied as a routine method of determination of tumour thickness? Meanwhile, re-excision is required following histopathological verification? Is it necessary to have 2 surgical interventions? The two surgical interventions are a burden for the patients and create prerequisites for contradicting opinions, statements, and subsequent results, which ultimately slows down the patient’s staging and the introducing more precise treatments. Based on the logic (and further aided by the clinical picture and dermatoscopy), we decided to operate selected cases of patients with cutaneous melanomas with a field of surgical security of 1cm in all directions when clinical, and dermatoscopic data are indicative of melanoma in situ or thin melanomas (less than 1 cm). Optimal results were achieved, with one surgical intervention and subsequent rehospitalisation spared for the patient.CONCLUSIONS:An answer to the question whether it is better not to follow the guidelines strictly (since, as a rule, they are generally recommended and somewhat misleading in certain circles of specialists, and as we have already found, also lead to unjustified logical secondary excisions), or update t...

The Future of Personalized Medicine: One Step Melanoma Surgery

“…Malignant melanoma is a disease, the diagnosis and treatment of which put clinicians to a serious test of the mind and raise the question of whether they tend to be flexible and innovative [3].…”

“…This requires a rethinking of the current therapeutic strategy in order to reduce relapses after therapy and patient mor-tality in general. Surgery remains the main method in the early treatment of primary melanoma [3]. Surgical treatment of melanoma refers to certain rules, which include primary excision of melanoma with a surgical safety margin of 0.5 cm in all directions, subsequent histological examination of the removed lesion and determination of Breslow tumor thickness [4].…”

Comparative Analysis of the ʺScholasticʺ Recommendations of the AJCC From 2011 for the Surgical Treatment of Cutaneous Melanoma with the Newly Suggested Guidelines for OSMS From the Bulgarian Society For Dermatologic Surgery!

“…For a more detailed presentation of the differences in AJCC and OSMS recommendations, we have systematized data in tabular form (Table 1 and 2). What unites the two treatment models is that excisions and, respectively, in the two-stage model- the re-excisions, are dependent on the Breslow tumor thickness [1], [2], [3], [4], [5], [6], [7].…”

“…Within the newly introduced OSMS, all cutaneous melanomas (regardless of their thickness) can be operated within one surgical session [3], [4], [5], [6], [7]. When this thickness is between 1.01 - 2.0 mm, the operation can again be performed within one surgical intervention, with a safety margin of 1 cm in all directions combined with SLND (Table 2) [3], [4], [5], [6], [7]. Thus, the AJCC’s recommendations on the final security field and SLND are respected and clearly defined but within one intervention [3], [4], [5], [6], [7].…”

The One Step Melanoma Surgery (OSMS): A New Chance for More Adequate Surgical Treatment of Melanoma Patients!?

“…Recently published data are evidencing that the single-step melanoma surgery is also applicable to patients with clear clinical and dermatoscopic criteria for thin cutaneous melanomas, even without the need for preoperative tumour thickness measurement [3], [9], [10], are also of interest. Re-thinking the approach to patients with skin melanomas is yet to come [10].…”