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

Tchernev, Georgi; Temelkova, Ivanka

doi:10.3889/oamjms.2019.147

Cited by 6 publications

(8 citation statements)

References 11 publications

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“…Tumor thickness in cutaneous melanomas is in fact the main indicator determining the plan of action, the choice of surgical boundaries, re-excision, additional determination of a draining lymph node and possible lymph dissection [8,9]. One step melanoma surgery offers a new innovative approach, which is undoubtedly one of the innovations in medicine of our time [10,11]. The innovation is applicable to almost all patients with clear clinical and dermatoscopic criteria for dysplastic nevi, thin cutaneous melanomas or melanoma in situ lesions, even without the need for preoperative ultrasound measurement of tumor thickness [12].…”

Section: Discussionmentioning

confidence: 99%

“…When the locoregional lymph nodes are affected, the primary lesion is removed within one surgical session together with them, observing a field of operative safety of 2 cm in all directions ( Table 2). If the lymph nodes are not clinically and ultrasound affected, it is not recommended to determine a draining lymph node (even in tumors over 4 mm thick) due to the likely presence of metastases [3,5,10].…”

Section: Breslow Thickness Recommended Surgical Marginsmentioning

confidence: 99%

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The Future of Personalized Medicine: One Step Melanoma Surgery

Tchernev¹,

Poterov²,

Malev³

2020

Acta Medica Bulgarica

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The divergent, personalized approach in the surgical treatment of cutaneous melanoma is the one in which the treatment of the neoplasm differs from that proposed within the generally accepted standards or guidelines. According to their presumption, guidelines are not obligatory for the treatment of a certain type of disease and cannot replace the judgment of the clinician. Which to a large extent determines the freedom (or possible one) of the clinician‘s action regarding the „personalization“ in the choice of a new, divergent therapy. It is interesting, for example, that the occurrence of locoregional recurrences in patients with melanoma after guideline therapy insures clinicians against both criticism of treatment choice and the end results. However, the lack of recurrences after innovative/personalized surgical treatment of cutaneous melanoma is accompanied for unknown reasons by a serious dose of unwarranted criticism. The fact is that a personalized surgical approach in the treatment of skin melanomas and the recommended by AJCC guidelines approach lead to exactly the same end results and that should not be ignored. The difference lies in the fact that this end result can be achieved by one step melanoma surgery (OSMS), for example, which is carried out in a single surgical session. Several advantages of OSMS can be noted: 1) it provides high efficiency in a short time, even in the initial stage of the disease, 2) it is cost-effective, and 3) according to initial clinical observations we have a much lower to no propensity for locoregional relapses.

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Section: Discussionmentioning

confidence: 99%

Section: Breslow Thickness Recommended Surgical Marginsmentioning

confidence: 99%

The Future of Personalized Medicine: One Step Melanoma Surgery

Tchernev¹,

Poterov²,

Malev³

2020

Acta Medica Bulgarica

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“…The present case was treated according to the recommendations of the AJCC during two surgical sessions (1, Table 1). We raise and discuss the possibility of One Step Melanoma Surgery in the patient described (OSMS) (Table 2) [5].…”

Section: Discussionmentioning

confidence: 99%

(OSMS)- One Step Melanoma Surgery for Nevoid melanoma?

Tchernev¹,

Temelkova²,

Lozev³

et al. 2020

CRDOA

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We describe a 48-year-old patient with a present cutaneous pigment lesion located in the left scapular area. About 15 years duration of the finding, as the lesion being suspected clinically and dermatoscopically for cutaneous melanoma. The patient was initially treated with a surgical margin of 0.5 cm in all directions, with a tumor thickness of 3 mm immediately established afterwards. The subsequent surgical session 9 days later (as recommended by the AJCC) included: 1) removal of 4 sentinel lymph nodes: 3 of them located infrascapularly and one axillary apically to the left and 2) reexcision of the primary surgical wound with a safety margin of 1.5 cm in all directions. Lymph node involvement data are lacking and the patient is staged as IIA (T3a N0M0).

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“…Therefore, the therapeutic approach for such type of lesions should be unified and consistent with the differential diagnosis. In case of suspected nodular melanoma or melanoma below 1 mm thin (as a possible differential diagnosis in our patient also), it would be good to think with one step forward, namely, performance of initial resection of the lesion with a surgical safety margin of 1 cm (within the one step melanoma surgery (OSMS) model), which in turn: 1) is adequate for the vascular lesion and 2) in the event of thin melanoma, this surgical safety margin is also adequate and does not require re-excision [3,4].…”

mentioning

confidence: 99%