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.

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.