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Surgery and radiotherapy in the treatment of cutaneous melanoma

Identifieur interne : 006449 ( Main/Exploration ); précédent : 006448; suivant : 006450

Surgery and radiotherapy in the treatment of cutaneous melanoma

Auteurs : A. Testori [Italie] ; P. Rutkowski [Pologne] ; J. Marsden [Royaume-Uni] ; L. Bastholt [Danemark] ; V. Chiarion-Sileni [Italie] ; A. Hauschild [Allemagne] ; A. M. M. Eggermont [Pays-Bas]

Source :

Annals of Oncology [ 0923-7534 ] ; 2009.

RBID : ISTEX:CEA6A1B66FC186603A0C38D6E6573D195BFEEA16

Abstract

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 12 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.

Url:

DOI: 10.1093/annonc/mdp257

Affiliations:

Allemagne, Danemark, Italie, Pays-Bas, Pologne, Royaume-Uni
Angleterre, Lombardie, Midlands de l'Ouest, Schleswig-Holstein
Birmingham, Kiel, Milan

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<front><div type="abstract">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 12 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.</div>
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Surgery and radiotherapy in the treatment of cutaneous melanoma

Surgery and radiotherapy in the treatment of cutaneous melanoma

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