Primary Melanoma: from History to Actual Debates

Alessandro A.E. Testori, Stephanie A. Blankenstein, Alexander C.J. van Akkooi

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of Review: This review describes the long scientific background followed to design guidelines and everyday clinical practice applied to melanoma patients. Surgery is the first option to cure melanoma patients (PTS) at initial diagnosis, since primary cutaneous lesions are usually easily resectable. An excisional biopsy of the lesion, with minimal clear margins, can be obtained in the vast majority of cases. Punch biopsies may be proposed only in case of large lesions located on specific cosmetic or functional areas like the face, extremities, or genitals where a mutilating complete resection would not be performed without prior histological diagnosis. Recent Findings: After the histologic confirmation of melanoma, definite surgical excision of the scar and surrounding tissue is planned, to obtain microsatellite free margins. The width of these margins has been identified following the results of several clinical trials and it is either 1 or 2 cm, depending on the Breslow thickness of the primary tumor. Following the latest staging system proposed by the American Joint Cancer commission (AJCC), a sentinel node biopsy (SNB) is usually performed in case of a primary lesion > 0.8 mm thickness or for high-risk thinner lesions, if no evidence of nodal involvement has been identified clinically or radiographically. Summary: Surgical management of primary melanoma is well established. There is debate on the optimal surgical margins for 1–2 mm melanomas. There are specific considerations for special primaries (bulky, extremity, mucosal). Sentinel node (SN) evaluation does not improve survival, but is routinely used as staging.

Original languageEnglish
Article number112
JournalCurrent Oncology Reports
Volume21
Issue number12
DOIs
Publication statusPublished - Dec 1 2019

Keywords

  • Excisional margins
  • Lymph node dissection
  • Melanoma
  • Sentinel node biopsy
  • Surgery

ASJC Scopus subject areas

  • Oncology

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