The adequate treatment for malignant melanoma is a stepwise procedure
that can be followed by clicking through the module DECISION FINDING
(see navigation list to the left).
You may navigate through more available treatment options for malignant
melanoma by simply clicking on either image of each page. For your
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HOW TO PROCEED IF A SUSPICIOUS LESION REQUIRES CLARIFICATION
The first step of any cancer treatment is a diagnostic one.
(1) It has to confirm or rule out malignant melanoma
micromorphologically (histology, immunohistochemistry).
(2) It has to assess morphologic risk group parameters on the excised
tissue (microstaging).
(3) It has to assess the potential lymphonodal involvement (lymphatic
mapping + sentinel lymph node biopsy), if (2) has verified a primary
tumor of more or equal than 1.0 MM vertical tumor thickness.
In many instances, the primary goal is to
clarify a suspicious skin lesion. In most cases, a simple excisional
biopsy (local anesthesia will do, outpatient procedure) will be
sufficient and can be considered definitive treatment, if
(1) the suspicious lesion was benign on histology (no melanoma), or
(2) the suspicious lesion was shown to be early melanoma only, with the
tumor cells being confined to the superficial epidermal layer (which is
the so-called
MELANOMA IN-SITU melanoma type).
If the tumor has been shown to have already penetrated the skin's basal
membrane (which separates the EPIDERMIS from the underlying soft
tissue), the resection margin has to be extended. This could require a
second surgical intervention as this finding is usually not available,
unless the histology report of the (first) surgical procedure was
rendered. If there is a need to perform a second surgical intervention,
it should not be delayed for more than 1 week. Also, to assess the
potential lymph node involvement of a verified melanoma, it may be
required to have a lymphatic mapping and a sentinel lymph node biopsy
done in addition.
FIRST STEP = DIAGNOSTIC
Excision biopsy: local anesthesia + histological examination (including
immunohistochemistry: S-100, HMB-45, Melan-A, etc.)
Biopsy resection margin: 2 mm
Determination of hisTOPathological microstaging parameters (pathology
lab).
SECOND STEP = DEFINITIVE SURGERY + STAGING
According to the assessed vertical tumor thickness: Extension of the
resection margin, either in one or two surgery intervention steps
(1 = biopsy, 2 = after histology).
Thickness < 1.0 mm: Resection margin 1 CM
Thickness > 1.0 mm and < 2.0 MM: Resection margin 2 CM
Thickness > 2.0 mm: Resection margin 2 CM
Thickness > 3.0 mm: Resection margin 3 CM
Thickness > 4.0 mm: Resection margin 3 CM (+ HD-Adjuvant
Interferon-alfa, see separate page)
Melanoma patients confirmed to have had melanoma > 1.0 MM in vertical
tumor thickness require to undergo lymphatic mapping and sentinel lymph
node bopsy for the purpose of adequate lymphonodal staging. This may
also apply in some patients, for whom histology has shown large areas of
partial tumor regression, indicating that the "true" tumor volume had
been previously been bigger, although the vertical thickness has not
exceeded 1.0 MM on pathology assessment.
