Morton, NEJM 2006

Groups:

·       wide excision with SLNB (biopsy)

·       wide excision and observation of regional nodal basin (obs)

o   underwent delayed lymphadenectomy if nodal recurrences became clinically detectable

·       It’s an interim analysis of a multi-centre study comparing SLNB with clinical observation (q3 months) of the regional drainage basin.

·       Basically, the point is, SLNB good, observation bad because once these patients develop clinically evident disease, therapeutic resection at that point carries a higher mortality.

Link:

Groin Dissection for Melanoma

Describe groin dissection for melanoma ...

borders of femoral triangle
- inguinal ligament
- sartorius
- adductor longus muscle

Indications for SLNB for Melanoma

- >1mm thickness
- <1mm thickness, BUT ulcerated
- <1mm thickness, BUT Clark's level 4-5
- lesions with unknown depth of invasion
- lesions with regression

Classification of Melanoma Metastases

Satellite Metastases:
- metastatic disease within 2cm of primary lesion

In Transit Metastases:
- distant mets >2cm from primary disease

Melanoma Subtypes

If you are walking on the "LANDS" you'll get melanoma

Lentigo maligna
-less common 10%
- slow growing and large

Acral Lentiginous
- rare 1-5%

Nodular Sclerosing
- 2nd most common 15-30%
- aggressive and develop rapidly

Desmoplastic
- wider margins advocated

Superficial Spreading
- most common 70%
- not necessarily associated with sun exposed skin