Malignant Melanoma - Sentinel Lymph Node Biopsy and Surgical Procedures

摘要

Ongoing controversies in melanoma surgery involve the extent of excisions in primary tumors, but also the value of diagnostic or palliative procedures. As yet, surgical removal is regarded to be the most effective treatment for primary malignant melanomas, since it can cure the majority of patients with less advanced tumors and controls local disease. Despite the fact that the basic importance of surgery in managing these patients has always been beyond question, the discussion about its extent and the role of elective procedures in the care of stage I and II melanomas is still vivaciously sustained. However, a 'less is more' policy has become validated by several studies in particular with regard to the use of smaller excisions of only 1 cm in tumors up to 2 mm thickness and of 2-3 cm for thicker melanomas.In critical anatomical sites of acral lentiginous types and lentigo maligna melanomas microscopically controlled surgery has almost replaced wide excisions in order to preserve tissue structure and function. Reduced safety margins enable us to cover most defects by primary closure or simple skin flap techniques.