MANAGEMENT OF CUTANEOUS MELANOMA IN THE UNITED-STATES

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  • 1 January 1984
    • journal article
    • research article
    • Vol. 158  (4) , 311-318
Abstract
Melanoma is an especially important malignant disease for surgeons to known about, since it can be cured with surgical treatment if diagnosed at an early stage. In the American College of Surgeons Melanoma Survey [USA] of 4545 melanoma patients diagnosed during 1980, the typical melanoma was relatively thin (< 1.5 mm), not ulcerated (except in 9%) and did not invade into the reticular dermis or beyond (level IV or V). The melanomas were most commonly located on the trunk in men and on the lower extremities in women. A total of 88% of the patients had no clinical evidence of metastases to regional nodes or to distant sites at the time of initial diagnosis. Only a small proportion (1%) of patients in the survey were black; in most of these patients, their melanoma were located on the feet or hands. The treatment of melanoma was surgical in 92.5% of the patients, with the majority of patients undergoing a wide excision of the melanoma as the initial form of treatment. Only 1/5 of the patients underwent elective regional node dissection for suspected micrometastases; most of these patients had a tumor thickness > 1.5 mm or a lesion invading to the reticular dermis (level III, IV or V). While the Breslow Microstaging Method is now recognized as the most important parameter that predicts the clinical course of the patient, this parameter was reported in only 45% of the patients in the survey. The natural history of melanoma is changing, since the disease is incresing in frequency and becoming more curable. Surgical treatment should be tailored to the biological aggressiveness of each individual patient''s melanoma. This can be estimated by integrating such prognostic factors as the melanoma thickness, the presence or absence of ulceration, the level of invasion, the anatomic site and the gender of the patient.