The incidence of melanoma is increasing at a rate exceeding that of all other solid tumors.41 Devesa S.S., Blot W.J., Stone B.J. , et al. Recent cancer trends in the United States J Natl Cancer Inst 1995 ; 87 : 175-182 [cross-ref]
Cliquez ici pour aller à la section Références In the United States alone, an estimated 44,200 new cases and 7300 deaths from melanoma occurred in 1999.63 Landis S.H., Murray T., Bolden S. , et al. Cancer statistics, 1999 CA Cancer J Clin 1999 ; 49 : 8-31 [cross-ref]
Cliquez ici pour aller à la section Références 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 Balch C.M., Urist M.M., Karakousis C.P. , et al. Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial Ann Surg 1993 ; 218 : 262-267 [cross-ref]
Cliquez ici pour aller à la section Références, 26 Cascinelli N. Margin of resection in the management of primary melanoma Semin Surg Oncol 1998 ; 14 : 272-275 [cross-ref]
Cliquez ici pour aller à la section Références, 85 National Institutes of Health Consensus conference: Diagnosis and treatment of early melanoma JAMA 1992 ; 268 : 1314-1319
Cliquez ici pour aller à la section Références, 105 Veronesi U., Cascinelli N. Narrow excision (1-cm margin): A safe procedure for thin cutaneous melanoma Arch Surg 1991 ; 126 : 438-441
Cliquez ici pour aller à la section Références show that no role for elective lymph node dissection exists for most patients (Table 2),8 Balch C.M., Soong S.J., Bartolucci A.A. , et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger Ann Surg 1996 ; 224 : 255-263 [cross-ref]
Cliquez ici pour aller à la section Références, 28 Cascinelli N., Morabito A., Santinami M. , et al. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: A randomised trial. WHO Melanoma Programme Lancet 1998 ; 351 : 793-796 [cross-ref]
Cliquez ici pour aller à la section Références, 51 Hochwald S.N., Coit D.G. Role of elective lymph node dissection in melanoma Semin Surg Oncol 1998 ; 14 : 276-282 [cross-ref]
Cliquez ici pour aller à la section Références, 96 Sim F.H., Taylor W.F., Ivins J.C. , et al. A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma: Preliminary results Cancer 1978 ; 41 : 948-956 [cross-ref]
Cliquez ici pour aller à la section Références, 103 Veronesi U., Adamus J., Bandiera D.C. , et al. Inefficacy of immediate node dissection in stage 1 melanoma of the limbs N Engl J Med 1977 ; 297 : 627-630 [cross-ref]
Cliquez ici pour aller à la section Références, 104 Veronesi U., Adamus J., Bandiera D.C. , et al. Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities Cancer 1982 ; 49 : 2420-2430 [cross-ref]
Cliquez ici pour aller à la section Références and have led to the approval by the US Food and Drug Administration (FDA) of the first systemic adjuvant therapy for melanoma.59 Kirkwood J.M., Strawderman M.H., Ernstoff M.S. , et al. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: The Eastern Cooperative Oncology Group Trial EST 1684 J Clin Oncol 1996 ; 14 : 7-17
Cliquez ici pour aller à la section Références 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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