Initial surgical management of melanoma of the skin and unusual sites
- Michael Stone, MD
Michael Stone, MD
- Chairman of Surgery
- Stamford Hospital
- 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
- Martin Weiser, MD
Martin Weiser, MD
- Section Editor — Colorectal Surgery
- Professor of Surgery
- Weill Cornell Medical College
- Memorial Sloan Kettering Cancer Center
- Hensin Tsao, MD, PhD
Hensin Tsao, MD, PhD
- Section Editor — Melanocytic Lesions and Disorders of Pigmentation
- Professor of Dermatology
- Harvard Medical School
- 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
Proper surgical management is critical for the diagnosis, staging, and optimal treatment of primary cutaneous melanoma.
The goals of surgery include:
●Histologic confirmation of the diagnosis, which ideally has been established through an appropriately planned biopsy. (See "Pathologic characteristics of melanoma".)
●Obtaining complete and accurate microstaging of the primary tumor to guide therapy. (See "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma".)
●Appropriate excision of the margin around the primary site to minimize the risk of local recurrence without compromising additional staging maneuvers (eg, sentinel lymph node biopsy potentially is less accurate after wide margin excision).
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- INITIAL BIOPSY
- WIDE LOCAL EXCISION
- Melanomas ≤2 mm thick (T1, T2)
- Melanomas 2.01 to 4 mm (T3)
- Melanomas >4 mm (T4)
- In situ melanomas
- Management of muscular fascia
- Experimental approaches
- REGIONAL LYMPH NODES
- ADJUVANT THERAPY
- Regional chemotherapy
- SKIN OF HEAD AND NECK
- Surgical management
- Regional nodes
- Adjuvant RT
- DESMOPLASTIC MELANOMA
- UNUSUAL SITES
- Acral melanomas
- - Subungual
- - Plantar/palmar
- Mucosal melanomas
- SURVEILLANCE AFTER SURGERY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Cutaneous melanoma
- Melanomas in unusual sites