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Surgical treatment of malignant melanoma of the skin

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Abstract

Surgery is the primary therapeutic modality in the treatment of primary melanomas and metastases to lymph nodes. Surgery also plays an important role in the therapy of locally recurrent tumors and distant metastases in selected cases. Wide excision of the primary tumor in stage I malignant melanoma results in a recurrence rate of about 2%. Surgical techniques for lymph node dissection are the same for melanoma as those performed for other malignancies. There is little question that dissection is necessary in obviously involved nodal areas, but controversy remains regarding the value of lymph node dissection of clinically uninvolved regional nodes. A prospective, randomized study by the World Health Organization has shown no improvement in survival for patients who underwent elective regional node dissection.

Surgery is the treatment of choice when melanoma recurs locally as a single cutaneous or subcutaneous nodule. Surgery may also result in long-term, disease-free survival in patients with a solitary distant metastasis after treatment of a primary lesion.

Résumé

Dans les mélanomes, la chirurgie doit être le traitement initial de la tumeur primitive et des métastases ganglionnaires. Elle a également un rôle important pour les récidives locales et pour les métastases à distance, dans certains cas sélectionnés. Après excision large de la tumeur primitive, la fréquence des récidives est d'environ 2%. Les techniques de curage ganglionnaire pour mélanome doivent être les mêmes que pour tout autre cancer. Ce curage est évidemment indispensable lorsque les ganglions sont manifestement envahis. Mais ses indications en absence d'envahissement ganglionnaire clinquement décelable sont discutées: à cet égard, une étude prospective, randomisée, faite par l'Organisation Mondiale de la Santé, n'a pas démontré d'amélioration des taux de survie.

La chirurgie est le traitement de choix pour les récidives locales sous forme de nodules cutanés ou sous-cutanés isolés. La chirurgie peut également apporter des survies de longue durée, sans récidive, chez les malades qui présentent, après traitement de la lésion primitive, une unique métastase à distance.

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Authors and Affiliations

  1. Istituto Nazionale per lo Studio e la Cura dei Tumori, Via G. Venezian 1, Milano, Italy

    Umberto Veronesi M.D. & Natale Cascinelli M.D.

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  1. Umberto Veronesi M.D.
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  2. Natale Cascinelli M.D.
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Veronesi, U., Cascinelli, N. Surgical treatment of malignant melanoma of the skin. World J. Surg. 3, 279–285 (1979). https://doi.org/10.1007/BF01556576

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