Cutaneous melanoma: Management of local recurrence
- Kenneth K Tanabe, MD
Kenneth K Tanabe, MD
- Section Editor — Gastrointestinal Malignancies
- Professor of Surgery
- Harvard Medical School
- Douglas Tyler, MD
Douglas Tyler, MD
- Department of Surgery
- University of Texas Medical Branch at Galveston
- Section Editors
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms; Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
- Russell S Berman, MD
Russell S Berman, MD
- Section Editor — Skin and Soft Tissue Surgery
- Chief of Surgical Oncology
- New York University Langone Medical Center
Melanoma is an aggressive neoplasm that can metastasize to virtually any organ of the body. For patients with cutaneous melanoma, the prognosis is related to the location, depth, and other biologic properties of the primary tumor, and the presence or absence of locoregional and distant metastatic disease. Surgery represents the principal treatment modality for primary cutaneous melanoma, and adequate excision is important to lessen the risk of a local recurrence. (See "Initial surgical management of melanoma of the skin and unusual sites" and "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma".)
Local recurrence is defined (albeit somewhat arbitrarily) as tumor regrowth within 2 cm of the surgical scar following definitive excision of a primary melanoma with appropriate surgical margins in order to standardize treatment endpoints in clinical trials . Recurrences that are more than 2 cm from the primary lesion but are not beyond the regional nodal basin are termed in transit metastases .
The management of locally recurrent melanoma will be discussed here. The management of in transit metastases is discussed separately. (See "Cutaneous melanoma: In transit metastases".)
MECHANISMS OF LOCAL RECURRENCE
Local recurrence potentially can arise as a result of one of several mechanisms. These include:
●Incomplete excision of the primary – Local recurrence may be due to incomplete excision of the primary tumor, even in the absence of a "positive surgical margin" in the resection specimen. Sampling error can prevent an accurate analysis of all margins of the surgical specimen. In theory, a wider excision with more generous margins might prevent this form of local recurrence. (See "Initial surgical management of melanoma of the skin and unusual sites", section on 'Cutaneous melanoma'.)
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- MECHANISMS OF LOCAL RECURRENCE
- RISK FACTORS FOR LOCAL RECURRENCE
- LOCAL RECURRENCE AND PROGNOSIS
- - Lymphatic mapping and SLN biopsy
- Adjuvant therapy
- Isolated limb perfusion
- - Adjuvant ILP
- Isolated limb infusion
- Systemic therapy
- Intralesional therapy of cutaneous disease
- - Talimogene laherparepvec
- - PV-10
- Radiation therapy
- SUMMARY AND RECOMMENDATIONS