MELANOMA : A Multidisciplinary Approach for the General Surgeon - 06/09/11

Doi : 10.1016/S0039-6109(05)70202-4 
Mark E. Reeves, MD, PhD *, Daniel G. Coit, MD *


The incidence of melanoma is increasing at a rate exceeding that of all other solid tumors.41 In the United States alone, an estimated 44,200 new cases and 7300 deaths from melanoma occurred in 1999.63 Fortunately, most melanomas are diagnosed at an early stage and can be cured by surgical excision, but because of the significant risk for morbidity and mortality associated with later-stage tumors, an increasing need for a multidisciplinary approach to their treatment exists.

Over the past 2 decades, significant advances in the understanding of the biology and treatment of this disease have been made. These advances have come from well-designed prospective, randomized clinical trials and basic science and translational research. For instance, data from prospective, randomized trials now provide clear guidelines for excision margins of primary melanomas (Table 1),11, 26, 85, 105 show that no role for elective lymph node dissection exists for most patients (Table 2),8, 28, 51, 96, 103, 104 and have led to the approval by the US Food and Drug Administration (FDA) of the first systemic adjuvant therapy for melanoma.59 Basic and translational research have led to a proliferation of promising experimental therapies, many of which are now being tested in phase 2 and 3 clinical trials.

Because of these advances, surgeons will be called on to direct the care of patients with melanoma in an increasingly multidisciplinary environment, so surgeons must understand the rationale, benefits, and side effects of the various treatment options. This article reviews some of the advances in techniques, treatment, and staging of melanoma with which surgeons should be familiar.

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 Address reprint requests to Daniel G. Coit, MD, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, e-mail: coitd@mskcc.org

© 2000  W. B. Saunders Company. Publié par Elsevier Masson SAS. Tous droits réservés.© 1996  © 1998 

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Vol 80 - N° 2

P. 581-601 - avril 2000 Retour au numéro
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