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Management of Melanoma Locoregional Recurrence

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Abstract

The incidence of melanoma continues to rise, and while most patients are diagnosed and treated early, up to 25% of patients may ultimately develop recurrent disease locally or within regional lymph nodes. Locoregional recurrence is defined as recurrence locally at the site of the primary lesion, regionally in the draining lymph node basin, and/or anywhere in between, but excludes distant metastatic disease. It can be characterized by as a “true recurrence” following adequate excision or “persistent” disease due to inadequate excision. Locoregional recurrence can also occur as in-transit metastases, defined as cutaneous or subcutaneous recurrence proximal to the primary lesion site and distal to the regional lymph node basin, generally greater than two centimeters from the original site of resection. Surgical removal is the mainstay of therapy for locoregional recurrence of melanoma and, at present, still offers the best chance for long-term cure. For those with unresectable disease, there are several additional treatment modalities. Regional therapy options include hyperthermic isolated limb perfusion (HILP) or isolated limb infusion (ILI), topical therapies, intralesional injection therapies, laser ablation, radiation therapy, and systemic therapy. With recent progress in systemic treatment options this approach can also be considered in those with unresectable, locoregional disease, especially when a clinical trial is available.

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Abbreviations

BCG:

Bacilli Calmette-Guérin

CTLA-4:

Cytotoxic T lymphocyte-associated antigen 4

DPCP:

Diphencyprone

GM-CSF:

Granuloctye-macrophage colony stimulating factor

HILP:

Hyperthermic isolated limb perfusion

ILI:

Isolated limb infusion

NCCN:

National Comprehensive Cancer Network

PD-1:

programmed cell death 1

SLNB:

Sentinel lymph node biopsy

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Authors and Affiliations

  1. Department of Surgical Oncology, Emory University Hospital, Atlanta, GA, USA

    Clara R. Farley M.D. & Keith A. Delman M.D., F.A.C.S.

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  1. Clara R. Farley M.D.
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Correspondence to Clara R. Farley M.D. .

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  1. Louisiana State University, New Orleans, Louisiana, USA

    Adam I. Riker

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Farley, C.R., Delman, K.A. (2018). Management of Melanoma Locoregional Recurrence. In: Riker, A. (eds) Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-319-78310-9_20

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