WLE LEFT LOWER EXTERMITY MASS SENTINEL LYMPH NODE BIOPSY SKIN
The whole lesion should be excised with a 1-3 mm margin of normal skin including sub-dermal fat. An excision biopsy is the recommended method for suspected malignant melanoma as it enables diagnosis and staging of the tumour and may determine future treatment and prognosis. Īn excision biopsy is indicated for lesions suspected of being a melanoma. It is suggested that minimising radiation, and the adoption of photo-protective measures, can significantly reduce the risk of developing melanoma. Risk factors for melanoma also include a positive family history or personal history of melanoma/non-melanoma cancer or in-situ skin carcinomas, large numbers of melanocitic naevi in childhood, and xeroderma pigmentosum. Countries with close proximity to the equator with predominantly fair-skinned populations have shown a higher preponderance to developing melanoma. Įpidemiological studies have found that blue, green or grey eyes, blonde or red hair, light complexion, freckles, sun sensitivity, and an inability to tan, are risk factors for the development of melanoma. Also worryingly a survey performed in the US in 2005 documented that up to 14% of adults, primarily women and young adults used an indoor tanning device on at least one occasion. However, despite the increase in public awareness, the practice of ultraviolet radiation protection behaviour is low. The most important of these is ultraviolet exposure where intermittent, unaccustomed sun exposure and sunburn were found to have considerable roles as risk factors for melanoma. Risk factors associated with the development of malignant melanoma are varied and include genetic susceptibility, exposure to ultraviolet radiation, and immunologic factors. The worldwide incidence of melanoma doubles every ten to fifteen years. Secondly, the updated and revised AJCC staging system will be discussed and current controversies addressed. Firstly, this chapter describes the appropriate surgical management of the primary tumour, the associated regional lymph node basin and distant metastatic disease. The two most important distinctions with previous guidelines are the incorporation of the mitotic rate of the primary tumor and the key role of the sentinel lymph node, including methods of analysis, in accurately staging clinically occult nodal disease. The new American Joint Committee on Cancer (AJCC) guidelines for the staging of melanoma were introduced into clinical practice in 2010. In addition, there has been a move away from the routine performance of elective regional lymph node dissection towards sentinel lymph node biopsy which is associated with less morbidity. The management of the primary tumour has become more conservative, with acceptance of narrower excision margins. Surgery, however, remains the mainstay of treatment and changes in the surgical approach have been guided by the greater understanding of melanoma pathogenesis. Īdvances in the understanding of the molecular mechanisms and immunology of melanoma have lead to the development of promising novel therapeutic agents. The corresponding 5-year overall survival rates are 98.2% for localized disease, 62.4% for regional lymph node involvement and 15.1% for distant melanomas. Approximately, 85% percent of patients with cutaneous melanoma are diagnosed at a localized stage, while 10% have associated regional lymph node involvement and 5% of patients will have distant metastatic disease at presentation. Similarly, in the UK, 12,818 new cases of malignant melanoma were diagnosed in 2010. In the United States 76,250 new cases are expected in 2012 with melanoma far outstripping other skin cancers in terms of mortality. The reported incidence of malignant melanoma continues to rise despite increasing understanding of its aetiology. An estimated 166,900 patients were diagnosed with malignant melanoma in developed countries last year.
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