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Surgical Oncology Manual pp 171–188Cite as

Melanoma

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Abstract

Melanoma represents less than 5 % of all skin cancers, but accounts for most attributable deaths. Its incidence has increased in the past 15 years. The mainstay of treatment for localized cutaneous melanoma remains wide local excision, aiming for a 1–2 cm margin depending on tumor depth. Sentinel lymph node biopsy (SLNB) is recommended for staging, locoregional control, and survival benefit for intermediate-thickness melanoma. Indications for SLNB in thin and thick melanomas are less clear. Treatment of isolated lymph node metastases is multimodal and often entails lymphadenectomy, but the role for active surveillance with a positive sentinel lymph node is currently being studied. Management options for in-transit disease include surgical resection, intralesional agents, topical therapy, and limb infusion/perfusion. Systemic therapies for distant metastatic melanoma have dramatically improved in the past decade with the use of targeted BRAF and MEK inhibitors, immunotherapy with anti-CTLA4 agents and PD-1 inhibitors.

Keywords

  • Cutaneous melanoma
  • Sentinel lymph node
  • BRAF inhibitor
  • Lymphadenectomy
  • Immunotherapy
  • In-transit lesion

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Authors and Affiliations

  1. Fellow, General Surgical Oncology, University of Toronto, Toronto, ON, Canada

    Mai-Kim Gervais M.D., F.R.C.S.C.

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Nicole J. Look Hong M.D., M.Sc., F.R.C.S.C., David R. McCready MS,MSc,FRCSC,FACS & Frances C. Wright M.D., M.Ed., F.R.C.S.C.

  3. Department of Medical Oncology, University of Toronto, Toronto, ON, Canada

    Teresa Petrella M.D., M.Sc., F.R.C.P.C.

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  1. Mai-Kim Gervais M.D., F.R.C.S.C.
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  2. Nicole J. Look Hong M.D., M.Sc., F.R.C.S.C.
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  3. David R. McCready MS,MSc,FRCSC,FACS
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Correspondence to Mai-Kim Gervais M.D., F.R.C.S.C. .

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Editors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Frances C. Wright

  2. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Jaime Escallon

  3. Department of Surgical Oncology, National Cancer Institute, Panama City, Panama

    Moises Cukier

  4. General Surgical Oncology, University of Toronto, 1X5, Ontario, Canada

    Melanie E. Tsang

  5. General Surgical Oncology, University of Toronto, Toronto, Ontario, Canada

    Usmaan Hameed

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Gervais, MK., Look Hong, N.J., McCready, D.R., Petrella, T., Wright, F.C. (2016). Melanoma. In: Wright, F., Escallon, J., Cukier, M., Tsang, M., Hameed, U. (eds) Surgical Oncology Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-26276-5_13

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