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Melanoma

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Surgical Oncology

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Abstract

Melanoma is a significant oncologic problem, affecting 2 % of people in the United States in their lifetime, many of whom are young. Risk factors for melanoma are multifactorial, including sun exposure, genetic skin disorder such as xeroderma pigmentosum, and personal history and family history of melanoma. Screening for melanoma is done by performing a careful physical examination, and diagnosis is made by a full-thickness biopsy to adequately determine the depth of invasion. Depth of invasion is the most important prognostic factor, followed by ulceration; the former helps determine the width of wide local excision as well as the need to perform a sentinel lymph node biopsy. Other prognostic factors such as nodal status, mitotic index, and anatomic location are also important. Prospective randomized controlled clinical trials have advanced our understanding of the optimal margin width, the need for sentinel lymph node biopsy, and the role of target-specific therapy. Surgical treatment consists of wide local excision with or without sentinel lymph node biopsy and/or regional lymphadenectomy. Although surgery is the mainstay of treatment for the disease, there may be a role for radiation therapy in locoregional control of advanced disease and novel systemic treatments in the advanced setting. Novel systemic treatment such as CTLA-4 inhibitors and BRAF and MEK inhibitors (MAP kinase signaling pathway) have shown significant improvement in overall survival. Isolated limb perfusion is an option for some patients with in-transit or satellite lesions. A rare percentage of melanomas are not found on the skin but instead are mucosal in nature (anal and vulvar melanomas). These melanomas portend a very poor prognosis.

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Authors and Affiliations

  1. Surgery, University of Florida, 1600 Southwest Archer Road, 100109, Gainesville, FL, 32610, USA

    Christiana Shaw M.D., M.S., F.A.C.S.

  2. Section of Surgical Oncology, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH, 44195, USA

    Stephen R. Grobmyer M.D.

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  1. Christiana Shaw M.D., M.S., F.A.C.S.
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Correspondence to Stephen R. Grobmyer M.D. .

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Editors and Affiliations

  1. Department of Surgery, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana, USA

    Quyen D. Chu

  2. Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey, USA

    John F. Gibbs

  3. John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, Louisiana, USA

    Gazi B. Zibari

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Shaw, C., Grobmyer, S.R. (2015). Melanoma. In: Chu, Q., Gibbs, J., Zibari, G. (eds) Surgical Oncology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1423-4_1

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