Skin Cancer Melanoma Surgical and Medical Treatment
Surgical intervention and medical management Stages are defined in the table as shown For stage IA disease, surgical intervention might be the only necessary therapy with a 1.0-cm margin. Re-excision with a 1.0-cm margin is recommended for tumors up to 2.0 mm thick and a margin of 2.0 cm is recommended for tumors up to 4.0 mm thick. Ulceration increases the risk of a lesion as the Breslow level can be underestimated. Sentinel node biopsy should be considered for stage IB and all stage II patients, patients with melanomas greater than 1 mm in histologic depth. The number of involved regional nodes is a stronger predictor of survival than the size of involved nodes. Sentinel lymph node status predicts both the risk of recurrence and mortality as shown. The therapeutic benefit of lymph node biopsy and thus removal of microscopic metastases is currently under study. For stages IIB, IIC and III, adjuvant treatment is often recommended with high-dose interferon. Oncology referral and/or tumor board review should be considered.