Melanoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D. Anum Ijaz M.B.B.S., M.D.[2]

Overview

The predominant treatment for primary melanoma is wide excision of the lesion margins. The choice of clinical margins is based on the tumor thickness. When lymph nodes are involved, complete dissection of the nodal basin is recommended.

Surgery

Surgical Margins for Wide Excision of Primary Melanoma

The National Comprehensive Cancer Network (NCCN) recommends wide excision of margins of primary melanoma.
The choice of clinical margins is based on the tumor thickness.^[1]
The margins may be individualized to accomodate anatomic and functional considerations.^[1]

Tumor thickness	Recommended Clinical Margins
In situ	0.5 cm
≤ 1 mm	1 cm
> 1 mm – 2 mm	1-2 cm
> 2 mm – 4 mm	2 cm
> 4 mm	2 cm

To view 2019 AAD Guidelines for Surgical Treatment of Primary Cutaneous Melanoma, click here

A blue stained sentinel axillary lymph node

Complete Lymph Node Dissection

The 2013 National Comprehensive Cancer Network (NCCN) recommends complete dissection of involved nodal basin is recommended.^[1]

Specific considerations for the groin lymph nodes

Indications for iliac and obturator lymph node dissection:

Positive pelvic CT, or
Cloquet’s node is positive

Elective iliac and obturator lymph node dissection

Clinically positive superficial node, or
≥ 3 superficial nodes are positive

To view 2019 AAD Guidelines for Sentinal Lymph Node Biopsy, click here

References

↑ ^1.0 ^1.1 ^1.2 Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A; et al. (2013). “Melanoma, version 2.2013: featured updates to the NCCN guidelines”. J Natl Compr Canc Netw. 11 (4): 395–407. PMID 23584343.

[pmid23584343-1] 1.0 ^1.1 ^1.2 Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A; et al. (2013). “Melanoma, version 2.2013: featured updates to the NCCN guidelines”. J Natl Compr Canc Netw. 11 (4): 395–407. PMID 23584343.

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