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Treatment of Primary Melanoma

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Current Management of Melanoma

Part of the book series: Updates in Surgery ((UPDATESSURG))

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Abstract

Patients with an atypical pigmented skin lesion or one which is suspected of malignancy must undergo removal with a narrow peripheral margin of 2 mm, including dermis down to the subcutaneous tissue. An incisional biopsy may be needed in aesthetic/functional areas or when dealing with particularly widespread primary lesions. Wide local excision after histological diagnosis is related to the characteristics of the primary lesion (Breslow’s depth) and requires removal of portions of healthy tissue surrounding the excised lesion in order to reduce any possibility of local cutaneous or subcutaneous recurrences. A reconstructive procedure may be necessary (skin graft, local flap, perforator flap, free flap). However, the simplest procedures and direct suture must be the priority whenever possible.

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References

  1. Karimipour DJ, Schwartz JL, Wang TS, et al. Microstaging accuracy after subtotal incisional biopsy of cutaneous melanoma. J Am Acad Dermatol. 2005;52(5):798–802.

    Article  Google Scholar 

  2. Mills JK, White I, Diggs B, et al. Effect of biopsy type on outcomes in the treatment of primary cutaneous melanoma. Am J Surg. 2013;205(5):585–90; discussion 590.

    Article  Google Scholar 

  3. Hieken TJ, Hernandez-Irizarry R, Boll JM, Jones Coleman JE. Accuracy of diagnostic biopsy for cutaneous melanoma: implications for surgical oncologists. Int J Surg Oncol. 2013;2013:196493. https://doi.org/10.1155/2013/196493.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bong JL, Herd RM, Hunter JA. Incisional biopsy and melanoma prognosis. J Am Acad Dermatol. 2002;46(5):690–4.

    Article  Google Scholar 

  5. Martin RC 2nd, Scoggins CR, Ross MI, et al. Is incisional biopsy of melanoma harmful? Am J Surg. 2005;190(6):913–7.

    PubMed  Google Scholar 

  6. Wright FC, Souter LH, Kellett S, et al. Primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in cutaneous melanoma: a clinical practice guideline. Curr Oncol. 2019;26(4):e541–50.

    Article  CAS  Google Scholar 

  7. Shumaker PR, Kelley B, Swann MH, Greenway HT Jr. Modified Mohs micrographic surgery for periocular melanoma and melanoma in situ: long-term experience at Scripps Clinic. Dermatol Surg. 2009;35(8):1263–70.

    Article  CAS  Google Scholar 

  8. Etzkorn JR, Sobanko JF, Elenitsas R, et al. Low recurrence rates for in situ and invasive melanomas using Mohs micrographic surgery with melanoma antigen recognized by T cells 1 (MART-1) immunostaining: tissue processing methodology to optimize pathologic staging and margin assessment. J Am Acad Dermatol. 2015;72(5):840–50.

    Article  CAS  Google Scholar 

  9. Bricca GM, Brodland DG, Ren D, Zitelli JA. Cutaneous head and neck melanoma treated with Mohs micrographic surgery. J Am Acad Dermatol. 2005;52(1):92–100.

    Article  Google Scholar 

  10. Bene NI, Healy C, Coldiron BM. Mohs micrographic surgery is accurate 95.1% of the time for melanoma in situ: a prospective study of 167 cases. Dermatol Surg. 2008;34(5):660–4.

    CAS  PubMed  Google Scholar 

  11. Stigall LE, Brodland DG, Zitelli JA. The use of Mohs micrographic surgery (MMS) for melanoma in situ (MIS) of the trunk and proximal extremities. J Am Acad Dermatol. 2016;75(5):1015–21.

    Article  Google Scholar 

  12. Hayes AJ, Maynard L, Coombes G, et al. Wide versus narrow excision margins for high-risk, primary cutaneous melanomas: long-term follow-up of survival in a randomised trial. Lancet Oncol. 2016;17(2):184–92.

    Article  Google Scholar 

  13. Gillgren P, Drzewiecki KT, Niin M, et al. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial. Lancet. 2011;378(9803):1635–42.

    Article  Google Scholar 

  14. Newton-Bishop JA, Nolan C, Turner F, et al. A quality-of-life study in high-risk (thickness ≥2 mm) cutaneous melanoma patients in a randomized trial of 1-cm versus 3-cm surgical excision margins. J Investig Dermatol Symp Proc. 2004;9(2):152–9.

    Article  Google Scholar 

  15. Moncrieff MD, Thompson JF, Quinn MJ, Stretch JR. Reconstruction after wide excision of primary cutaneous melanomas: part I—the head and neck. Lancet Oncol. 2009;10(7):700–8.

    Article  Google Scholar 

  16. Moncrieff MD, Thompson JF, Quinn MJ, Stretch JR. Reconstruction after wide excision of primary cutaneous melanomas: part II—the extremities. Lancet Oncol. 2009;10(8):810–5.

    Article  Google Scholar 

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Correspondence to Ilaria Baldelli .

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Baldelli, I., Santi, P.L., Raposio, E. (2021). Treatment of Primary Melanoma. In: Cafiero, F., De Cian, F. (eds) Current Management of Melanoma. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-45347-3_3

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  • DOI: https://doi.org/10.1007/978-3-030-45347-3_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-45346-6

  • Online ISBN: 978-3-030-45347-3

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