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Invasive Melanoma

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Evidence-Based Procedural Dermatology

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Abstract

Melanoma remains one of few malignancies with increasing incidence. Surgical removal of invasive melanoma is the first and most important therapeutic intervention. Historically, margins of up to 5 cm have been recommended for a wide local excision (WLE). However, randomized controlled trials comparing margin width have significantly narrowed the size of an appropriate WLE to 1–2 cm, depending on Breslow depth. Narrow margins have not been shown to worsen survival in these trials. More recently, refinements in Mohs surgery have allowed for the highest rate of local control when immunohistochemistry is employed, particularly for head and neck melanomas, which have a poor rate of local control with WLE. Perioperative issues include appropriate examination and counseling, consideration of sentinel lymph node biopsy, and taking patient preference into account. Safety of the various surgical modalities is related to the size of the excision and the delay between excision and repair, with advantages noted for smaller excisions and same-day repair.

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Authors and Affiliations

  1. Department of Dermatology, Walla Walla Clinic, Walla Walla, WA, USA

    David Panther

  2. Z & B Skin Cancer Center, Pittsburgh, PA, USA

    David G. Brodland

  3. Departments of Dermatology, Otolaryngology & Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    David G. Brodland

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  1. David Panther
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  1. Department of Dermatology, Northwestern University, Chicago, IL, USA

    Murad Alam

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Panther, D., Brodland, D.G. (2019). Invasive Melanoma. In: Alam, M. (eds) Evidence-Based Procedural Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-030-02023-1_62

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