title: Update and Review on the Surgical Management of Primary Cutaneous Melanoma.
abstract: The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization's 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1-2 cm for melanoma thickness of 1.01-2 mm, 2 cm margins for melanoma thickness of 2.01-4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm²) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 415, Los Angeles, CA 90015, USA. solmazniknamMD@gmail.com.
authors.forename: Solmaz Niknam
authors.initials: SN
authors.lastname: Leilabadi
authors.affiliation: Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 415, Los Angeles, CA 90015, USA. amie.chen1202@gmail.com.
authors.forename: Amie
authors.initials: A
authors.lastname: Chen
authors.affiliation: Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 415, Los Angeles, CA 90015, USA. TsaiS1@mail.amc.edu.
authors.forename: Stacy
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 415, Los Angeles, CA 90015, USA. vrljs92@yahoo.com.
authors.forename: Vinaya
authors.initials: V
authors.lastname: Soundararajan
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 412, Los Angeles, CA 90015, USA. silberma@usc.edu.
authors.forename: Howard
authors.initials: H
authors.lastname: Silberman
authors.affiliation: Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Suite 415, Los Angeles, CA 90015, USA. alex.wong@med.usc.edu.
authors.forename: Alex K
authors.initials: AK
authors.lastname: Wong
keywords: lymphadenectomy in melanoma; melanoma; primary cutaneous melanoma; sentinel lymph node biopsy in melanoma; surgical management of melanoma; surgical margins of melanoma