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10th
International Inter University Scientific Meeting
Academy of Studenica
PERSPECTIVES
IN MELANOMA MANAGEMENT
& NANOTECHNOLOGY IN BIOMEDICINE
Organizers:
Institute of Oncology
Sremska Kamenica; Union of Cancer Prevention
Societies of Vojvodina, Novi Sad; Clinic of Oncology, Nis; Institute
for Oncology and Radiology of Serbia, Belgrade Center for Bioengineering,
Faculty of Mechanical Engineering, University of Belgrade
President:
Vladimir Baltic Vice-presidents: Zlata
Janjic, Radan Dzodic, Borislava Nikolin; Djuro Koruga
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SURGICAL
MANAGEMENT OF MELANOMA - STATE OF ART
Janjiĉ Z.
Clinic for
plastic and reconstructive surgery, Institute of surgery, Clinical
center-Novi Sad, Serbia and Montenegro
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ABSTRACT
Early
recognition and treatment of melanoma is the course of action performed
to improve the patient's survival prospects. The surgical treatments
of the primary melanoma site has been made today more rational through
correlation's rate of local control with various margins of excision
in the context of the dominant prognostic indicator for primary
tumor, the thickness of the lesion. It is well known that for lesions
less than 1 mm just 1-cm excision margin is satisfactory according
to the results of a multiinstitutional, randomized, around surgical
trial around the word. For lesions with the thickness 1 - 4 mm a
2-cm excision is adequate. The lesions thicker than 4 mm should
be treated with excision margin larger than 2 cm in depending on
anatomic localisation.
For most patients with melanoma, the surgical excision with primary
closure, skin grafting or reconstruction with local flap is the
up the state of art of treatment of melanoma. The more complex plastic
or head and neck surgery techniques are particularly useful for
reconstruction of extensive surgical defects in that region. The
risk of a melanoma patient to develop metastases in regional lymph
nodes is related to the tumor thickness. For the thin melanoma it
is less than 5% while thick melanoma have more than 50% chance of
metastatic nodal involvement. The elective dissection has not been
shown to alter significantly the patient's survival and by now was
not recommended in any of the published papers. If regional lymph
node metastases are confirmed, a complete node dissection is considered
mandatory. Morton et assoc. in 1990 proposed the technique of sentinel
node biopsy procedure considering that the sentinel node should
therefore be the first regional site of melanoma metastasis. According
to Morton's group the incidence of false negative dissection was
less than 1%. A relative common site for recurrence of melanoma
in limbs is the skin or subcutaneous tissue between the primary
tumor site and the regional lymph node called in-transit recurrence
and easily treated with a simple excision. Contemporary, there is
still no effective therapeutic protocol that achieves satisfactory
long-term results in disseminated melanoma. Surgical treatment of
distant melanoma metastases is indicated for palliation of symptomatic
lesion or some solitary metastasis surgical treatment in depending
on patient's general health condition.
At the present time, the developments of clinical practice guidelines
are systematically and continuously developing statements to assist
surgeon and other practitioners in making decisions about the most
appropriate health care for patients with the specific clinical
stage of melanoma. |
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Keywords:
Melanoma, Surgical treatment, In-transit metastasis, Regional
metastasis, Distant metastasis, Recurrence |
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