Surgical Excision of Primary Melanoma

Melanoma skin cancer ---> primary melanoma ---> melanoma treatment ---> melanoma surgery

The primary purpose of a melanoma excision is to prevent local recurrence due to persistent disease. For melanoma in situ, excision margins of 0.5 to 1 cm are indicated. For invasive melanoma, wide excision of the primary tumor, with margins generally ranging from 1 to 2 cm, is indicated for local control. The optimal margin width remains somewhat controversial. The historical approach of excising all primary melanomas with a 3- to 5-cm margin is extinct. At least five randomized controlled trials failed to demonstrate a difference in overall survival or local recurrence with narrow (1 to 2 cm) versus wide (3 to 5 cm) margins. Of note, one trial demonstrated an increased risk of locoregional recurrence with 1 versus 3 cm margins for melanoma more than 2 mm thick.25 Hopefully, results from future randomized prospective trials will demonstrate how narrow a margin is truly safe and efficacious. Until more definitive data become available, current consensus guidelines recommend margins of 1 cm for melanoma of 1 mm or less thick, 1 to 2 cm for 1 to 2 mm thick, and at least 2 cm for greater than 2 mm thick.

Surgery for Metastatic Melanoma

Melanoma skin cancer ---> metastatic melanoma ---> melanoma treatment ---> melanoma surgery

Surgical excision of recurrent melanoma can be effective for palliation in patients with isolated recurrences in the skin, central nervous system, lung, or gastrointestinal tract. Surgical excision of solitary brain metastases has been shown to provide improved palliation and quality of life compared with brain irradiation. Resection of isolated pulmonary metastases or of subcutaneous recurrences is usually not considered curative but can result in significantly prolonged disease-free survival. Gastrointestinal lesions causing obstruction or bleeding should be considered for resection or bypass to relieve these symptoms.