Controversies in the diagnosis and treatment of early cutaneous melanoma

Abstract

Cutaneous melanoma (CM) is a disease with an unpredictable evolution mainly due to its high metastatic ability. The steadily increasing incidence and the poor outcome in advanced stages made this cancer an interesting field for many research groups. Given that CM is a curable disease in early stages, efforts have been made to detect it as soon as possible, which led to the diversification and refining of diagnosis methods and therapies. But, as the data from trials have been published, doubts about the indications and efficacy of established treatments have arisen. In fact, there is probably no single aspect of early CM that has not given birth to controversy. This article intends to present the current disputes regarding the early detection, diagnosis, treatment and postoperative follow-up of patients with localized CM. After analyzing both pros and cons, several conclusions were drawn, that reflect our experience in managing patients with early CM.

Keywords: diagnosis; early cutaneous melanoma; follow-up; treatment.

Fig. 1

Excision of suspicious lesion with 3 mm margin

Fig. 2

A 33-year-old woman with melanoma of the neck with a Breslow depth of 2,4 mm. (A) Site after initial excisional biopsy, (B) a 20 mm margin wide excision, (C) local defect after excision and sentinel lymph node, (D) Limberg fasciocutaneous flap for reconstruction, (E) wide excision and lymph node specimen