Melanoma (Treatment)
Melanoma may require very different treatments, depending upon its depth of invasion into the skin. So-called "thin" melanomas ( those measuring less than 0.75 mm in thickness under the microscope) are quite curable with adequate local excision. Because melanoma has great potential to spread ("metastasize") , adequate excision is critical.
This potential for spread also requires the physician to study the patient (with scans) for evidence of metastasis if the tumor is not of the "thin" variety. Because evaluation of tumor thickness is critical to treatment planning, pigmented lesions which are at all suspicious should never be burned or shaved off. They must be excised with the full thickness of skin so that proper evalutation of thickness can be accomplished.
Surgical excision will involve the removal of a generous wedge of skin and fat with a significant surrounding border of normal tissue. The size of this border of normal tissue will depend upon the thickness of the tumor. The tissue removed ( called the "specimen") can then be examined microscopically to see if the tumor has been completely removed. When all the edges of the resection are microscopically normal, the treatment is presumed to be adequate. Surgeons will employ a rapid pathological examination known as "frozen section" to examine the tissues while the patient is still in the operating room. The findings of this test are then corroborated with the more accurate "permanent section" which becomes available some days after surgery.

If the tumor is greater than 0.75 mm in thickness, and particularly if greater than 1mm, most surgeons will recommend a prophylactic lymph node dissection as part of the treatment. This involves the surgical removal of the lymph nodes from the area to which the tumor bed would normally drain, ( e.g the armpit or groin). Because this is significant surgery with potentially serious side effects, the patient should fully understand his/her options. Also, since there is difference of opinion among physicians as to when lymph node dissection is required on a prophylactic basis, obtaining a second opinion is often prudent. (Note: if physical examination of the regional lymph nodes reveals enlargement of these, lymph node dissection is then clearly indicated. This is known as "therapeutic" lymph node dissection).

2/21/00

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