This article appears in the following Annals of Oncology issue: Melanoma: Perspectives of the Global Melanoma Task Force [View the issue table of contents]
Articles |
Surgery and radiotherapy in the treatment of cutaneous melanoma
1 European Institute of Oncology, Division of Melanoma, Milan, Italy
2 M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland
3 University Hospital Birmingham, Birmingham, UK
4 Department of Oncology, Odense University Hospital, Denmark
5 Medical Oncology Unit, Istituto Oncologico Veneto–IRCCS, Padova, Italy
6 Department of Dermatology, University of Kiel, Kiel, Germany
7 Erasmus University Medical Center–Daniel den Hoed Cancer Center, Department of Surgical Oncology; Rotterdam, The Netherlands
* Correspondence to: Alessandro Testori, European Institute of Oncology, Via Ripamonti 435, Milan, Italy 20141; Tel: +39-057489459493; Fax: +39-057489091; E-mail: alessandro.testori{at}ieo.it
Adequate surgical management of primary melanoma and regional lymph node metastasis, and rarely distant metastasis, is the only established curative treatment. Surgical management of primary melanomas consists of excisions with 1–2 cm margins and primary closure. The recommended method of biopsy is excisional biopsy with a 2 mm margin and a small amount of subcutaneous fat. In specific situations (very large lesions or certain anatomical areas), full-thickness incisional or punch biopsy may be acceptable. Sentinel lymph node biopsy provides accurate staging information for patients with clinically unaffected regional nodes and without distant metastases, although survival benefit has not been proved. In cases of positive sentinel node biopsy or clinically detected regional nodal metastases (palpable, positive cytology or histopathology), radical removal of lymph nodes of the involved basin is indicated. For resectable local/in-transit recurrences, excision with a clear margin is recommended. For numerous or unresectable in-transit metastases of the extremities, isolated limb perfusion or infusion with melphalan should be considered. Decisions about surgery of distant metastases should be based on individual circumstances. Radiotherapy is indicated as a treatment option in select patients with lentigo maligna melanoma and as an adjuvant in select patients with regional metastatic disease. Radiotherapy is also indicated for palliation, especially in bone and brain metastases.
Key words: cutaneous melanoma, electrochemotherapy, limb perfusion, melanoma radiotherapy, melanoma surgery, sentinel node