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Current Oncology Reports

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01-12-2019 | Melanoma | Melanoma (RJ Sullivan, Section Editor)

Primary Melanoma: from History to Actual Debates

Authors: Alessandro A. E. Testori, Stephanie A. Blankenstein, Alexander C. J. van Akkooi

Published in: Current Oncology Reports | Issue 12/2019

Abstract

Purpose of Review

This review describes the long scientific background followed to design guidelines and everyday clinical practice applied to melanoma patients. Surgery is the first option to cure melanoma patients (PTS) at initial diagnosis, since primary cutaneous lesions are usually easily resectable. An excisional biopsy of the lesion, with minimal clear margins, can be obtained in the vast majority of cases. Punch biopsies may be proposed only in case of large lesions located on specific cosmetic or functional areas like the face, extremities, or genitals where a mutilating complete resection would not be performed without prior histological diagnosis.

Recent Findings

After the histologic confirmation of melanoma, definite surgical excision of the scar and surrounding tissue is planned, to obtain microsatellite free margins. The width of these margins has been identified following the results of several clinical trials and it is either 1 or 2 cm, depending on the Breslow thickness of the primary tumor. Following the latest staging system proposed by the American Joint Cancer commission (AJCC), a sentinel node biopsy (SNB) is usually performed in case of a primary lesion > 0.8 mm thickness or for high-risk thinner lesions, if no evidence of nodal involvement has been identified clinically or radiographically.

Summary

Surgical management of primary melanoma is well established. There is debate on the optimal surgical margins for 1–2 mm melanomas. There are specific considerations for special primaries (bulky, extremity, mucosal). Sentinel node (SN) evaluation does not improve survival, but is routinely used as staging.

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Title: Primary Melanoma: from History to Actual Debates
Authors: Alessandro A. E. Testori
Stephanie A. Blankenstein
Alexander C. J. van Akkooi
Publication date: 01-12-2019
Publisher: Springer US
Keywords: Melanoma
Melanoma
Published in: Current Oncology Reports / Issue 12/2019
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI: https://doi.org/10.1007/s11912-019-0843-x

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