MELANOMA: A Multidisciplinary Approach for the General Surgeon
Section snippets
SENTINEL LYMPHADENECTOMY
wThe management of the draining nodal basin in patients with clinically node-negative melanoma traditionally has been a source of controversy. Before the 1990s, two management options were available: (1) observation and (2) elective lymph-node dissection (ELND). A third option, sentinel lymph node biopsy (SLNB), is now available.
The likelihood of having occult nodal disease is directly related to the thickness of the primary melanoma (Table 3).46 Clearly, nodal observation is the best
ADJUVANT THERAPY
The risk for systemic recurrence after complete resection of nodal disease is 50% to 70% and is higher after resection of systemic disease.6, 10, 21, 23, 29, 71 This information has stimulated an ongoing intensive search for effective adjuvant therapies. In large, prospective, randomized trials, numerous agents have been shown to have no efficacy in an adjuvant setting after resection of high-risk melanoma. This list includes bacillus Calmette-GuƩrin (BCG), Corynebacterium parvum,
MOLECULAR STAGING
The American Joint Committee on Cancer staging system accurately predicts survival for patients with melanoma.71 This system stages patients according to the thickness of the primary tumor, lymph node or in-transit metastases, and distant metastases (Table 4), but significant heterogeneity exists within staging groups, especially stages II and III.71 Which patients in each of these staging groups are at higher risk for recurrence and death from systemic disease would be useful to know so that
SUMMARY
Advances in the understanding of the biology and treatment of melanoma have moved the care of melanoma patients into an increasingly multidisciplinary environment. Surgeons must understand these advances because they will often be responsible for directing the overall care of these patients.
Most patients with melanomas more than 1 mm in diameter and no evidence of metastatic disease should be offered SLNB to more accurately stage them and direct decisions about participation in postoperative
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Address reprint requests to Daniel G. Coit, MD, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, e-mail: [email protected]
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Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York