Surgical Procedures/Melanoma

Malignant melanoma is a neoplasm arising from the melanocytes in the epidermis. It is strongly associated with fair-skinned people with excessive sunlight exposure, particularly episodes of sunburn during childhood. It is commonest in areas with high sun exposure and a predominantly Caucasian population - eg. Australia, South Africa, the "Sunbelt" region of the United States.

Pathology

Macroscopic appearance

1. Superficial spreading melanoma
2. Nodular melanoma
3. Lentigo maligna melanoma
4. Acral lentiginous melanoma
5. Amelanotic melanoma

Staging

The AJCC / UICC TNM system is the current staging system. T stage is assessed on total thickness of the melanoma, and further categorised by the presence or absence of ulceration.

For full current details, the cancer.gov Physician's Data Query is recommended:

Treatment

A general strategy can be summarised as:

1. Confirming the diagnosis
2. Staging the disease
3. Deciding on best stage-appropriate treatment according to current evidence, local resources and patient physiology

This is achieved by:

1. Excisional biopsy with a close border
2. Further staging, if justified by clinical findings or by thickness >= 1 mm
3. Definitive excision and closure
4. Consideration of (staging) sentinel lymph node biopsy or (therapeutic) lymphadenectomy
5. Consideration of adjuvant therapies (interferon) or clinical trials
6. Consideration of treatment of any metastatic disease.

This field of surgery is developing rapidly, with major trials recently published or in progress.