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Cutaneous Melanoma pp 573–594Cite as

Treatment of Primary Melanomas

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Abstract

The great majority of patients with newly diagnosed melanomas have early-stage disease that is clinically localized to the primary site (AJCC stages I and II). Surgical strategies to treat early-stage melanomas today include two main components: wide excision of the primary melanoma (or biopsy site) and evaluation of the regional lymph node basin by sentinel lymph node biopsy. In the past, the recommended treatment of primary melanoma was aggressive surgery, involving wide resection margins of 3–5 cm around the primary melanoma and, frequently, elective radical dissection of the regional node basin. However, this strategy was not based on sound evidence, but principally on the clinical impressions of surgeons in the early twentieth century.

Although such radical management is no longer considered appropriate, surgery remains the single most effective treatment modality for clinically localized melanoma. Over time, a better understanding of the factors governing or predicting the natural history of melanoma and the results of clinical trials that were designed to study less aggressive surgical approaches have led to evidence-based recommendations for surgical excision margins. The objectives that led to this evolution in care were to provide durable local disease control and to optimize the chance of cure, while at the same time minimizing morbidity associated with the treatment. In this chapter the evidence supporting current margin recommendations for surgical excision of primary melanomas is presented and discussed, and the management of melanomas with unusual histologic findings is also considered.

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Authors and Affiliations

  1. Melanoma Institute Australia, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson

  2. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    John F. Thompson

  3. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Michael A. Henderson

  4. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia

    Gabrielle Williams

  5. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Merrick I. Ross

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  1. John F. Thompson
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  2. Michael A. Henderson
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  3. Gabrielle Williams
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  4. Merrick I. Ross
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Correspondence to John F. Thompson .

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Editors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Charles M. Balch

  2. Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA

    Michael B. Atkins

  3. Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany

    Claus Garbe

  4. Departments of Surgical Oncology and Cancer Biology, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey E. Gershenwald

  5. Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Allan C. Halpern

  6. Departments of Medicine, Dermatology, and Translational Science, University of Pittsburgh and UPMC Hillman Cancer Center, Pittsburgh, PA, USA

    John M. Kirkwood

  7. Divisions of Cancer Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Grant A. McArthur

  8. Melanoma Institute Australia, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson

  9. Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Arthur J. Sober

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Thompson, J.F., Henderson, M.A., Williams, G., Ross, M.I. (2020). Treatment of Primary Melanomas. In: Balch, C., et al. Cutaneous Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-030-05070-2_52

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  • DOI: https://doi.org/10.1007/978-3-030-05070-2_52

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