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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
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.
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.
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.
Bong JL, Herd RM, Hunter JA. Incisional biopsy and melanoma prognosis. J Am Acad Dermatol. 2002;46(5):690–4.
Martin RC 2nd, Scoggins CR, Ross MI, et al. Is incisional biopsy of melanoma harmful? Am J Surg. 2005;190(6):913–7.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
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
Download citation
DOI: https://doi.org/10.1007/978-3-030-45347-3_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-45346-6
Online ISBN: 978-3-030-45347-3
eBook Packages: MedicineMedicine (R0)