Surgical Techniques for Treatment of Primary Cutaneous Melanoma

  • June K. Robinson
Part of the Methods in Molecular Medicine book series (MIMM, volume 61)


The incidence and mortality rates of melanoma increased dramatically from 1973 to 1994, rising 120.5 and 38.9%, respectively (1). From 1990 to 1994, men had higher incidence (17.3/100,000) and mortality rates (3.5/100,000) than women (incidence: 11.6/100,000; mortality: 1.7/100,000) and had more melanomas on the trunk or the head and neck; women had more on the lower limbs, but the largest increases for an anatomic site were for the trunk. Incidence rates for birth cohorts born after 1945 seem to be stabilizing. Mortality rates of melanoma are declining for women born in the 1930s or later and men born since the 1950s.


Sentinel Lymph Node Sentinel Lymph Node Biopsy Primary Melanoma Wide Local Excision Thin Melanoma 
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  1. 1.
    Hall, H. I., Miller, D. R., Rogers, J. D., and Bewerse, B. B. (1999) Update on the incidence and mortality from melanoma in the United States, J. Am. Acad. Dermatol. 40, 35–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Fremgen, A. M., Bland, K. I., McGinnis, L. S., Eyre, H. J., McDonald, C. J., and Menck, H. R. (1999) Clinical highlights from the national cancer data base. Cancer 49, 145–148.Google Scholar
  3. 3.
    Beahrs, O. H., Henson, D. E., Hutter, R. V. P.,et al. eds. (1992) Manual for Staging of Cancer, 4th ed. JB Lippincott, Philadelphia, pp. 143–147.Google Scholar
  4. 4.
    Breslow, A. (1970) Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann. Surg. 172, 902–908.PubMedCrossRefGoogle Scholar
  5. 5.
    Clark, W. H. Jr., From, L., Bernardino, E. A., et al. (1969) The histogenesis and biologic behavior of primary human malignant melanoma of the skin. Cancer Res. 29, 705–727.PubMedGoogle Scholar
  6. 6.
    Balch, C. M., Soong, S. J., Shaw, H. M., et al. An analysis of prognostic factors in 8500 patients with cutaneous melanoma, in Cutaneous Melanoma, 2nd ed. (Balch, C. M., Houghton, A. N., Milton, G. W., et al., eds.),. JB Lippincott, Philadelphia, pp. 165–199.Google Scholar
  7. 7.
    Garbe, C., Buttner, P., Bertz., J, et al. (1995) Primary cutaneous melanoma: identification of prognostic groups and estimation of individual prognosis for 5093 patients. Cancer 75, 2484–2491.PubMedCrossRefGoogle Scholar
  8. 8.
    Balch, C. M., Cascinelli, N., Drzewiecki, K. T., et al. (dy1992) A comparison of prognostic factors worldwide, in Cutaneous Melanoma, 2nd ed. (Balch, C. M., Houghton, A. N. A., Milton, G. W., et al., eds.), JB Lippincott, Philadelphia, pp. 188–199.Google Scholar
  9. 9.
    Balch, C. M., Soong, S. J., Murad, T. M., et al. (dy1981) A multifactorial analysis of melanoma. III. Prognostic factors in melanoma patients with lymph node metastases (stage II). Ann. Surg. 193, 377–388.PubMedCrossRefGoogle Scholar
  10. 10.
    Albertini, J. J., Cruse, C. W., Rapport, D., et al. (dy1996) Intraoperative radiolymphoscintigraphy improves sentinel lymph node identification for patients with melanoma. Ann. Surg. 223, 217–224.PubMedCrossRefGoogle Scholar
  11. 11.
    Ross, M., Reintgen, D. S., and Balch, C. (1993) Selective lympadenectomy: emerging role of lymphatic mapping and sentinel node biopsy in the management of early stage melanoma. Semin. Surg. Oncol. 9, 219–223.PubMedGoogle Scholar
  12. 12.
    Shivers, S. C., Wang, X., Li, W., et al. (1998) Molecular staging of malignant melanoma. JAMA 280, 1410–1415.PubMedCrossRefGoogle Scholar
  13. 13.
    Urist, M. M. (1996) Surgical management of primary cutaneous melanoma. CA 46, 217–224.PubMedGoogle Scholar
  14. 14.
    Barnhill, R. L., Mihm, M. C., and Fitzpatrick, T. B. (1993) Neoplasms: malignant melanoma, in Dermatology in General Medicine, 4th ed., (Fitzpatrick, T. B., Eisen, A. Z., Wolff, K., et al., eds.), McGraw-Hill, New York, pp. 1078–1115.Google Scholar
  15. 15.
    Brown, M. (1997) Staging and prognosis of melanoma. Semin. Cutan. Med. Surg. 16(2), 113–121.CrossRefGoogle Scholar
  16. 16.
    Balch C. M., Buzaid, A. C., Atkins, M. D., et al. (2000) A new American joint committee on cancer staging system for cutaneous melanoma. Cancer 88, 1484–1491.PubMedCrossRefGoogle Scholar
  17. 17.
    Handley, W. S. (1907) The pathology of melanocytic growths in relation to their operative treatment. Lancet 1, 927–996.Google Scholar
  18. 18.
    Kelly, J. N., Sagabiel, R. W., Calderon, W., et al. (dy1984) The frequency of local recurrence and microsatellitosis as a guide to re-excision margins for cutaneous malignant melanoma. Ann. Surg. 200, 759–763.PubMedGoogle Scholar
  19. 19.
    Breslow, A. and Macht, S. P. (1977) Optimal size for resection margin for thin cutaneous melanoma. Surg. Gynecol. Obstet. 145, 691–702.PubMedGoogle Scholar
  20. 20.
    Goldsmith, L. A., Askin, F. B., Chang, A. E., Cohen, C., Dutcher, J. P., Gilgor, R. S., Green, S., Harris, E. L., Havas, S., Robinson, J. K., Swanson, N. A., and Tempero, M. A. (1992) Diagnosis and treatment of early melanoma. NIH consensus development panel on early melanoma. JAMA 268, 1314–1319.CrossRefGoogle Scholar
  21. 21.
    Balch, C. M., Urist, M. M., Karakousis, C. P., et al. (1993) Efficacy of 2 cm surgical margins for intermediate-thickness melanomas (1 to 4 mm): results of a multi-institutional randomized surgical trial. Ann. Surg. 218, 262–269.PubMedCrossRefGoogle Scholar
  22. 22.
    Veronesi, U. and Cascinelli, N. (1991) Narrow excision (1 cm margin): a safe procedure for thin cutaneous melanoma. Arch. Surg. 126, 438–441.PubMedCrossRefGoogle Scholar
  23. 23.
    Piepkorn, M. and Barnhill, R. L. (1996) A factual, not arbitrary, basis for choice of resection margins in melanoma. Arch. Dermatol. 132, 811–814.PubMedCrossRefGoogle Scholar
  24. 24.
    Bagley, F. H., Cady, B., Lee, A., et al. (1981) Changes in clinical presentation and management of malignant melanoma. Cancer 47, 2126–2134.PubMedCrossRefGoogle Scholar
  25. 25.
    Schmoeckel, C., Bockelbrink, A., Bockelbrink, H., et al. (1983) Low-risk and high-risk malignant melanoma, III. Eur. J. Cancer Clin. Oncol. 19, 245–249.PubMedCrossRefGoogle Scholar
  26. 26.
    Zeitels, J., La Rossa, D., Hamilton R., et al. (1988) A comparison of local recurrence and resection margins for stage I primary cutaneous malignant melanomas. Plast. Reconstr. Surg. 81, 688–693.PubMedCrossRefGoogle Scholar
  27. 27.
    O’Rourke, M. G. E. and Altmann, C. R. (1993) Melanoma recurrence after excision: is a wide margin justified? Ann. Surg. 217, 2–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Thorn, M., Pouten, F., Berstrome, R., et al. (1994) Clinical and histopathologic predictors of survival in patients with malignant melanoma: a population-based study in Sweden. J. Natl. Cancer Inst. 86, 761–769.PubMedCrossRefGoogle Scholar
  29. 29.
    Ang, K. K., Byers, R. M., Peters, L. J., et al. (1990) Regional radiotherapy as adjuvant treatment for head and neck malignant melanoma. Arch. Otolaryngol. Head Neck Surg. 116, 169–172.PubMedCrossRefGoogle Scholar
  30. 30.
    Storm, F. K. and Mahvi, D. M. (1994) Treatment of primary melanoma, in Malignant Melanoma, 1st ed., (Lejeune, F. J., Chaundhuri, P. K., and Das Gupta, T. K., eds.), McGraw-Hill, New York, pp. 193–204.Google Scholar
  31. 31.
    Levy, E., Silverman, M. K., Vossaert, K. A., et al. (1991) Late recurrence of malignant melanoma: a report of five cases, a review of the literature and a study of associated factors. Melanoma Res. 1, 63–67.PubMedCrossRefGoogle Scholar
  32. 32.
    Vilmer, C., Bailly, C., Le Doussal, V., et al. (1999) Thin melanomas with unusual aggressive behavior: a report of nine cases. J. Am. Acad. Dermatol. 34, 439–444.CrossRefGoogle Scholar
  33. 33.
    Slinguff, C. L., Dodge, R. K., Stanley, W. E., et al. (1992) The annual risk of melanoma progression: implications for the concept of cure. Cancer 70, 1917–1927.CrossRefGoogle Scholar
  34. 34.
    Rhodes, A. R. (1995) Public education and cancer of the skin: what do people need to know about melanoma and non-melanoma skin cancer. Cancer 75(Suppl), 613–636.CrossRefGoogle Scholar
  35. 35.
    Provost, N., Marghoob, A. A., Kopf, A. W., DeDavid, M., Wasti, Q., and Bart, R. S. (1997) Laboratory test and imaging studies in patients with cutaneous malignant melanomas: a survey of experienced physicians. J. Am. Acad. Dermatol. 36, 711–720.PubMedCrossRefGoogle Scholar
  36. 36.
    Rinne, D., Baum, R. P., Hor, G., and Kaufman, R. (1998) Primary staging and followup of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography. Cancer 82, 1664–1671.PubMedCrossRefGoogle Scholar
  37. 37.
    Morton, D. L., Wanek, L., Nizze, J. A., Elashoff, R. M., and Wong, J. H. (1991) Improved long-term survival after lymphadenectomy of melanoma metastatic to regional lymph nodes. Ann. Surg. 214, 491–501.PubMedCrossRefGoogle Scholar
  38. 38.
    Das Gupta, T. K. (1977) Results of treatment of 269 patients with primary cutaneous melanoma: a five-year prospective study. Ann. Surg. 186, 201–209.PubMedCrossRefGoogle Scholar
  39. 39.
    Sim, F. H., Taylor, W. F., Ivins, J. C., Pritchard, D. J., and Soule, E. H. (1978) A prospective randomized study of the efficacy of routine elective lymph node lymphadenectomy in management of malignant melanoma: preliminary results. Cancer 41, 948–956.PubMedCrossRefGoogle Scholar
  40. 40.
    Veronesi, U., Adamus, J., Bandiera, D. C., et al. (1977) Inefficacy of immediate node dissection in stage I melanoma of the limbs. N. Engl. J. Med. 297, 627–631.PubMedCrossRefGoogle Scholar
  41. 41.
    Balch, C. M., Soong, S. J., Bartolucci, A. A., et al. (1996) Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann. Surg. 224, 255–266.PubMedCrossRefGoogle Scholar
  42. 42.
    Cascinelli, N., Marabito, A., Santinani, M., et al. (1998) Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomized trial. Lancet 351, 793–796.PubMedCrossRefGoogle Scholar
  43. 43.
    Norman, J., Wells, K., Kearney, R., Cruse, C. W., Berman, C., and Reintgen, D. S. (1993) Identification of lymphatic basins in patients with cutaneous melanoma. Semin. Surg. Oncol.9, 224–2PubMedGoogle Scholar
  44. 44.
    Morton, D. L., Wen, D. R., Wong, J. H., et al. (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch. Surg. 127, 392–399.PubMedCrossRefGoogle Scholar
  45. 45.
    Alex, J. C. and Krag, D. N. (1993) Gamma-probe guided localization of lymph nodes. Surg. Oncol. 2, 137–143.PubMedCrossRefGoogle Scholar
  46. 46.
    Cochran, A. J., Wen, D., and Morton, D. L. (1988) Occult tumor cells in lymph nodes of patients with pathological stage I malignant melanoma. Am. J. Surg. Pathol. 12, 612–618.PubMedCrossRefGoogle Scholar
  47. 47.
    Gershenwald, J. E., Colome, M. I., Lee, J. E., et al. (1998) Patterns of recurrence following a negative sentinel lymph node biopsy in 243 patients with Stage I or II melanoma. J. Clin. Oncol. 6, 2253–2260.Google Scholar
  48. 48.
    Carson, K. F., Wen, D. R., Li, P. X., Lana, A. M., Bailly, C., Morton, D. L., and Cochran, A. J. (1996) Nodal nevi and cutaneous melanoma. Am. J. Surg. Pathol. 20, 834–840.PubMedCrossRefGoogle Scholar
  49. 49.
    Kirkwood, J. M., Strawderman, M. H., Ernstoff, M. S., et al. (1996) Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Co-operative Oncology Group Trial EST 1684. J. Clin. Oncol. 14, 7–17.PubMedGoogle Scholar
  50. 50.
    Dhawan, S. S., Wolfe, D. J., Rabinowitz, H. S., et al. (1990) Lentigo maligna. Arch. Dermatol. 126, 928–930.PubMedCrossRefGoogle Scholar
  51. 51.
    de Berker, D. (1991) Lentigo maligna and Mohs. Arch. Dermatol. 127, 421.PubMedGoogle Scholar
  52. 52.
    Robinson, J. K. (1994) Margin control for lentigo maligna. J. Am. Acad. Dermatol. 31, 79–85.PubMedCrossRefGoogle Scholar
  53. 53.
    Cohen, L. M., McCall, M. W., Hodge, S. J., et al. (1994) Successful treatment of lentigo maligna and lentigo maligna melanoma with Mohs’ micrographic surgery aided by rush permanent section. Cancer 73, 2964–2970.PubMedCrossRefGoogle Scholar
  54. 54.
    Stonecipher, M. R., Leshin, B., Patrick, J., et al. (1993) Management of lentigo maligna and lentigo maligna melanoma with paraffin-embedded tangential sections: utility of immunoperoxidase staining and supplemental vertical sections. J. Am. Acad. Dermatol. 29, 589–594.PubMedCrossRefGoogle Scholar
  55. 55.
    Griego, R. D. and Zitelli, J. A. (1998) Mohs micrographic surgery using HMB-45 for a recurrent acral melanoma. Dermatol. Surg. 24, 1003–1006.PubMedCrossRefGoogle Scholar
  56. 56.
    Gross, E. A., Andersen, W. K., and Rogers, G. S. (1999) Mohs microscopic excision of lentigo maligna using Mel-5 for margin control. Arch. Dermatol. 135, 15–17.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2001

Authors and Affiliations

  • June K. Robinson
    • 1
  1. 1.Cardinal Bernardin Cancer CenterLoyola University ChicagoMaywood

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