Surgical Excision of Primary Melanoma
- In situ, 0.5 to 1 mm lesion: 0.5 cm margin
- <1 mm lesion: 1 cm margin
- 1 to 2 mm lesion: consider 1 to 2 cm margin
- 1 to 4 mm lesion: 2 cm margin
- >4 mm lesion: >2 cm margin
|
(Balch et al., 2001; Cohn-Cedermark et al., 2000; Haigh, DiFronzo, & McCready, 2003; Khayat et al., 2003; Thomas et al., 2004) |
A |
| Sentinel Lymph Node Biopsy (SNLB) |
SNLB should be considered for patients with:
- Primary melanoma >1 mm
- Primary melanoma <1 mm, but with negative prognostic features (i.e., ulceration, Clark level IV/V, vertical growth phase [VGP])
|
(Estourgie et al., 2003; Essner et al., 1999; Morton et al., 2006; Landi et al., 2000; Bedrosian et al., 2000; Wagner et al., 2000; Morton et al., 2005) |
B |
Recommend use of multiple imaging techniques:
- Blue vital dye
- Radioactive colloid
- Gamma probe
|
(Estourgie et al., 2003; Essner et al., 1999; Morton et al., 2006; Landi et al., 2000; Duprat et al., 2005; Cafiero et al., 1998; Rossi et al., 2006; Morton et al., 2005) |
B |
Measures to minimize probability of missed sentinel node metastasis include:
- Serial sectioning
- Hematoxylin and eosin staining
- Immunohistochemistry
- RT-PCR
|
(Estourgie et al., 2003; Essner et al., 1999; Morton et al., 2006; Landi et al., 2000; Duprat et al., 2005; Cafiero et al., 1998; Rossi et al., 2006; Giese et al., 2005; Gradilone et al., 2004; Kammula et al., 2004; Morton et al., 2005) |
B |
Complete Lymph Node Dissection (CLND)
CLND is recommended for patients with:
- Positive sentinel lymph node (determined by biopsy)
- Clinically obvious metastatic melanoma in regional lymph nodes, even when multiple basins are involved
- Distant metastasis (as palliative treatment)
|
(Morton et al., 2006; Pu et al., 2003; Balch et al., 2000; Morton et al., 2005; Kretschmer et al., 2004) |
C |
Systemic Treatment
- Patients who cannot be successfully treated with surgery should be referred to an oncologist for further treatment options.
|
Expert Opinion |
D |
