Our Summary

This research paper discusses the role of surgery in the treatment of cutaneous melanoma, a type of skin cancer responsible for most skin cancer deaths. Over recent years, the treatment of this disease has been revolutionized due to the introduction of immunotherapy and targeted therapy for patients at stages III and IV. Consequently, the paper suggests that the role of surgery in melanoma treatment needs to be reassessed.

The authors focus on the use of surgery for diagnosis, treatment of the primary tumor, and treatment of metastases, which are secondary malignant growths at a distance from a primary site of cancer. They discuss the investigation of neoadjuvant therapy, which is treatment that is administered before the main treatment. They also touch on the idea of surgery for treatment-resistant metastases.

In conclusion, the paper asserts that surgery remains a crucial method for diagnosing and treating primary melanoma. However, it notes that therapeutic lymphadenectomy, a surgery to remove lymph nodes, is less important now while surgery in sentinel lymph node diagnostics and metastasectomy, the surgical removal of metastases, are still valuable. The trend appears to be moving towards less invasive surgical procedures.

FAQs

  1. What is the role of surgery in the treatment of melanoma in the current era of advanced medical treatments?
  2. How has the role of therapeutic lymphadenectomy changed in the treatment of melanoma?
  3. What is the importance of sentinel lymph node biopsy in the diagnosis and treatment of primary melanoma?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sentinel lymph node biopsy is to inform them that this procedure is used to determine if cancer has spread to nearby lymph nodes, and can help guide further treatment decisions. It is important for the patient to understand the purpose of the biopsy and to follow any pre- and post-procedure instructions provided by their healthcare team. Additionally, the doctor may explain the risks and benefits of the procedure, and discuss any potential alternative options based on the patient’s individual case.

Suitable For

Patients with cutaneous melanoma who are at high risk for lymph node involvement are typically recommended for sentinel lymph node biopsy. This includes patients with tumors that are thicker than 1 mm, tumors that are ulcerated, or tumors with high mitotic rates. Additionally, patients with clinically negative lymph nodes but with a high risk of microscopic lymph node involvement based on tumor characteristics may also be recommended for sentinel lymph node biopsy. Ultimately, the decision to perform sentinel lymph node biopsy should be made on a case-by-case basis by a multidisciplinary team of healthcare providers.

Timeline

Before Sentinel Lymph Node Biopsy:

  1. Patient undergoes a physical examination and medical history review.
  2. Patient may undergo imaging tests, such as ultrasound or MRI, to determine the location and size of the melanoma.
  3. If the melanoma is suspected to have spread to the lymph nodes, a sentinel lymph node biopsy may be recommended.
  4. Patient may receive counseling and education about the procedure and potential risks and benefits.

After Sentinel Lymph Node Biopsy:

  1. The sentinel lymph node is identified and removed during surgery.
  2. The lymph node is sent to a pathologist for examination to determine if there are any cancer cells present.
  3. Depending on the results, further treatment options may be recommended, such as additional surgery, chemotherapy, or immunotherapy.
  4. The patient will have follow-up appointments to monitor for any signs of recurrence or metastasis.
  5. Patient may undergo additional testing, such as imaging scans or blood tests, to monitor their condition and response to treatment.

What to Ask Your Doctor

  1. What is a sentinel lymph node biopsy and how is it performed?
  2. What are the risks and benefits of undergoing a sentinel lymph node biopsy?
  3. How will the results of the biopsy impact my treatment plan?
  4. Are there any alternative methods for determining lymph node involvement?
  5. How will the biopsy results affect my prognosis?
  6. What is the likelihood of complications from the biopsy procedure?
  7. Will I need additional treatment if the biopsy shows lymph node involvement?
  8. How long will it take to receive the results of the biopsy?
  9. What can I expect during the recovery period after the biopsy?
  10. Are there any restrictions or precautions I should follow after the biopsy?

Reference

Authors: Wollina U. Journal: Dermatol Ther. 2022 Dec;35(12):e15966. doi: 10.1111/dth.15966. Epub 2022 Nov 16. PMID: 36336954