0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16
Melanoma 965➣Congenital nevomelanocytic nevus (giant or small)
➣Lentigo maligna
tests
Biopsy
■Excisional biopsy with narrow margin of normal skin
■Incisional or punch biopsy acceptable when total excisional biopsy
cannot be performed due to large size or location
■Provide your dermatopathologist with as much tissue as possible so
that an accurate diagnosis can be established.
differential diagnosis
■Nevi (benign, dysplastic, blue)
■Seborrheic keratosis
■Solar lentigo
■Pigmented basal cell carcinoma
■Pyogenic granuloma
■Hemangioma
management
■Establish the correct diagnosis with a proper biopsy.
■Refer to a skin cancer specialist such as a dermatologist or a surgical
oncologist.
specific therapy
Primary Melanoma
■Standard treatment in primary cutaneous melanoma is the complete
excision of the lesion
➣Guidelines for melanoma in situ
Surgically excise with 5-mm margins of normal skin extending
to subcutaneous layer.
➣Guidelines for stage I melanoma
≤2 mm thick, 1-cm surgical margins extending to fascia
>2 mm thick, 2-cm surgical margins extending to fascia
■Elective lymph node dissection (ELND)
➣Controversial – directed by positive sentinel node
■Sentinel lymph node biopsy
➣First node draining the lymphatic basin (sentinel node) – predicts
the presence or absence of melanoma in the entire basin
➣Lymphoscintigraphy and a radioactive tracer used to locate the
sentinel node
➣Sentinel lymph node biopsy is recommended for lesions 1 mm
or greater in depth.