The primary goals in melanoma follow-up are: 1) early detection of local-regional tumor recurrence, 2) early identification of second primary tumors (including melanoma as well as other skin cancers), 3) continuing patient education, and 4) psychological support.193Each follow-up visit should include an inquiry into new or changing skin lesions. A review of systems (Table 3) concerning distant metastasis should be asked.98 A thorough examination of the skin and mucosa is required, with particular attention paid to the original melanoma site and associated draining nodal basins. Photodocumentation and dermoscopy have proven helpful in monitoring change in patients who have a substantial number of nevi.221 This vigilant monitoring is particularly important among elderly patients where a change in nevus appearance is more likely to be a melanoma compared with younger patients.221 Each follow-up visit should be viewed as an opportunity to re-educate patients on the ABCDE melanoma warning signs and the importance of monthly skin self-examination.
Studies have demonstrated that melanoma patients who practice monthly self-examination are diagnosed with thinner lesions at the time of recurrence.221Sun education including the use of sunscreen, avoidance of
822 Curr Probl Surg, November 2006
peak sun hours, shade seeking, sun protective clothing, and the potential risks of tanning booths should all be emphasized.
Conclusion
Over the past few decades, melanoma has escalated into a problem of epidemic proportions. Fortunately, significant research advances have been achieved in recent years.204,208,212,222,223Intense efforts in the areas of melanoma vaccination, gene therapy, HLA immunoprinting, and gene profiling at the genomic, as well as the proteomic level, will likely play an important role in future research endeavors. Given the association with sun exposure, melanoma is considered a preventable disease. Decreased incidence and mortality hinges on patient as well as physician education, prevention, early diagnosis, and improved treatment for advanced disease.
Ultimately, the key to impacting melanoma survival rates lies in well-organized, multi-institutional studies that enroll patients who are staged accurately and therefore share a similar prognosis.
REFERENCES
1. Rigel DS. The effect of sunscreen on melanoma risk. Dermatol Clin 2002;20:601-6.
2. Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10-30.
3. Surveillance, Epidemiology and End Results. 2005. http://seer.cancer.gov. Ac-cessed December 13, 2005.
4. Beddingfield FC. The melanoma epidemic: Res Ipsa Loquitur. The Oncologist 2003;8:459-65.
5. Rigel DS, Carucci JA. Malignant melanoma: prevention, early detection, and treatment in the 21st century. CA Cancer J Clin 2000;50:215-36.
6. Fisher SR, O’Brien CJ Head and neck melanoma. In: Balch CM, Houghton AN, Sober AJ, Soong SJ, editors. Cutaneous Melanoma. St. Louis, MO: Quality Medical Publishing; 2003.
7. Fisher SR. Elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck: analysis of 1444 patients from 1970 to 1998.
Laryngoscope 2002;112:99-110.
8. O’Brien CJ, Coates AS, Petersen-Schaefer K, Shannon K, Thompson JF, Milton GW, et al. Experience with 998 cutaneous melanomas of the head and neck over 30 years. Am J Surg 1991;162:310-4.
9. Peralta EA, Yarington T, Glenn MG. Malignant melanoma of the head and neck:
effect of treatment on survival. Laryngoscope 1998;108:220-3.
10. Fisher SR, Reintgen DS, Seigler HF. Juvenile malignant melanoma of the head and neck. Laryngoscope 1988;98:184-9.
11. Pacella SJ, Lowe L, Bradford C, Marcus BC, Johnson T, Rees R. The utility of sentinel lymph node biopsy in head and neck melanoma in the pediatric population.
Plast Reconstr Surg 2003;112:1257-65.
12. Kobayashi N, Muramatsu T, Yamashina Y, Shirai T, Ohnishi T, Mori T. Melanin
reduces ultraviolet-induced DNA damage and killing rate in cultured human melanoma cells. J Invest Dermatol 1993;101:685-9.
13. Pathak MA, Stratton K. Free radicals in human skin before and after exposure to light. Arch Biochem Biophys 1968;123:468-76.
14. Riley PA. Melanin. Int J Biochem Cell Biol 1997;29:1235-9.
15. Gilchrest BA, Eller MS, Gellar AC, Yaar M. The pathogenesis of melanoma induced by ultraviolet radiation. N Engl J Med 1999;340:1341-8.
16. Holman CD, Armstrong BK, Heenan PJ. Etiology of common acquired melano-cytic nevi: constitutional variables, sun exposure, and diet. J Natl Cancer Inst 1986;77:329-35.
17. Nelemans PJ, Groenendal H, Kiemeney LA, Rampen FH, Ruiter DJ, Verbeek AL.
Effect of intermittent exposure to sunlight on melanoma risk among indoor workers and sun-sensitive individuals. Environ Health Perspect 1993;101:252-5.
18. Bentham G, Aase A. Incidence of malignant melanoma of the skin in Norway, 1955-1989: associations with solar ultraviolet radiation, income and holidays abroad. Int J Epidemiol 1996;25:1132-8.
19. Bayerl C, Taake S, Moll I, Jung EG. Characterization of sunburn cells after exposure to ultraviolet light. Photodermatol Photoimmunol Photomed 1995;
11:149-54.
20. Gilcrest BA, Treloar V, Grass AM, Yaar M, Szabo G, Flynn E. J Invest Dermatol 1986;87:102-7.
21. Fitzpatrick TB, Ortonne JP: Normal skin color and general considerations of pigmentary disorders. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz AI, editors. Fitzpatrick’s Dermatology in General Medicine. New York:
McGraw Hill Medical Publishing; 2003.
22. Yaar M, Gilcrest BA. Ageing and photoageing of keratinocytes and melanocytes.
Clin Exp Dermatol 2001;26:583-91.
23. Tsao H, Sober AJ Atypical melanocytic nevi. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz AI, editors. Fitzpatrick’s Dermatology in General Medicine. New York: McGraw Hill Medical Publishing; 2003.
24. Berwick M, Weinstock MA. Epidemiology: current trends. In: Balch CM, Hough-ton AN, Sober AJ, Soong SJ, editors. Cutaneous Melanoma. St. Louis, MO: Quality Medical Publishing; 2003.
25. Kennedy C, Bajdik CD, Willemze R, et al. The influence of painful sunburns and lifetime sun exposure on the risk of actinic keratoses, seborrheic warts, melanocytic nevi, atypical nevi, and skin cancer. J Invest Dermatol 2003;1087-93.
26. Rigel DS. Identification of those at highest risk for development of malignant melanoma. Adv Dermatol 1995;10:151-70.
27. Johnson TM, Hamilton T, Lowe L. Multiple primary melanomas. J Am Acad Dermatol 1998;39:422-7.
28. Schmalbach CE, Johnson TM, Bradford CR. The management of head and neck melanoma. In: Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, et al, editors. Cummings Otolaryngology Head & Neck Surgery.
Philadelphia: Elsevier Mosby; 2005.
29. Kraehn GM, Schartl M, Peter RU. Human malignant melanoma: a genetic disease?
Cancer 1995;75:1228-37.
30. Kamb A, Gruis NA, Weaver-Feldhaus J, Liu Q, Harshman K, Tavtigian SV, et al.
824 Curr Probl Surg, November 2006
A cell cycle regulator potentially involved in genesis of many tumor types. Science 1994;264:436-40.
31. Aitken J, Welch J, Duffy D, Milligan A, Green A, Martin N, et al. CDKN2A variants in a population-based sample of Queensland families with melanoma.
J Natl Cancer Inst 1999;91:446-52.
32. Piepkorn K. Melanoma genetics: and update with focus on the CDKN2A(p16)/ARF tumor suppressors. J Am Acad Dermatol 2000;42:705-22.
33. Clark WH Jr., Reimer RR, Greene MH, Ainsworth AM, Mastrangelo MJ. Origin of familial malignant melanoma from heritable melanocytic lesions: the B-K mole syndrome. Arch Dermatol 1978;114:732-8.
34. Lynch HT, Frichot BC, Lynch JF. Familial atypical multiple mole-melanoma syndrome. J Med Genet 1978;15:352-6.
35. Greene MH, Goldin LR, Clark WH Jr, Lovien E, Kraemer KH, Tucker MA, et al.
Familial cutaneous malignant melanoma: autosomal dominant trait possibly lined to the Rh locus. Proc Natl Acad Sci USA 1983;80:6071-5.
36. Marghoob AA, Kopf AW, Rigel DS, Bart RS, Friedman RS, Yadav S, et al. Risk of cutaneous malignant melanoma in patients with “classic” atypical mole syn-drome. A case-control study. Arch Dermatol 1994;130:993-8.
37. Marghoob AA, Schoenbach SP, Kopf AW, Orlow SJ, Nossa R, Bart RS. Large congenital melanocytic nevi and the risk of developing malignant melanoma: a prospective study and review of the world literature. Arch Dermatol 1997;132:170-5.
38. Greene MH, Clark WH Jr, Tucker MA, Mraiemer KH, Elder DE, Fraser MC. High risk of malignant melanoma in melanoma-prone families with dysplastic nevi. Ann Int Med 1985;102:458-65.
39. Kraemer KH, Levy DD, Parris CN, Gozukara EM, Moriwaki S, Adelberg S, et al.
Xeroderma pigmentosum and related disorders: examining the linkage between defective DNA repair and cancer. J Invest Dermatol 1994;103:96S-101S.
40. Cleaver JE. Defective repair replication of DNA in xeroderma pigmentosum.
Nature 1968;218:652-6.
41. Ceballos PI, Ruiz-Maldonado R, Milun MC Jr. Melanoma in children. N Engl J Med 1995;332:656-62.
42. Greene MH, Young TI, Clark WH Jr. Malignant melanoma in renal-transplant recipients. Lancet 1981;1:1196-9.
43. Reynolds P, Suanders LD, Layefsky ME, Lemp GF. The spectrum of acquired immunodeficiency syndrome (AIDS)-associated malignancies in San Francisco, 1980-1987. Am J Epidemiol 1993;137:19-30.
44. Aboulafia DM. Malignant melanoma in an HIV-infected man: a case report and literature review. Cancer Invest 1998;16:217-24.
45. McGregor JM, Newell M, Ross J, Krkam N, McGibbon DH, Barley C. Cutaneous malignant melanoma and human immunodeficiency virus (HIV) infection: a report of three cases. Br J Dermatol 1992;126:516-9.
46. Smith CH, McGregor JM, Barker JN, Morris RW, Rigdon SP, MacDonald DM.
Excess melanocytic nevi in children with renal allografts. J Am Acad Dermatol 1993;28:51-5.
47. Baird EA, McHenry PM, Mackie RM. Effect of maintenance chemotherapy in childhood on numbers of melanocytic naevi. BMJ 1992;305:799-801.
48. Naldi L, Adamoli L, Fraschini D, Corbelta A, Imberti L, Reseghett A, et al. Number
and distribution of melanocytic nevi in individuals with a history of childhood leukemia. Cancer 1996;77:1402-8.
49. Rhodes AR, Albert LS, Weinstock MA. Congenital nevomelanocytic nevi: propor-tionate area expansion during infancy and early childhood. J Am Acad Dermatol 1996;34:51-62.
50. Marghoob AA. Congenital melanocytic nevi: evaluation and management. Derma-tol Clin 2002;20:607-16.
51. Consensus Development Panel. Precursors to malignant melanoma. JAMA 1984;251:1864-94.
52. Bittencourt FV, Marghoob AA, Kopf AW, Koenig KL, Bart RS. Large congenital melanocytic nevi and the risk of developing malignant melanoma and neurocuta-neous melanocytosis. Pediatrics 2000;106:736-41.
53. Anderson KW, Baker SR, Lowe L, Su L, Johnson TM. Treatment of head and neck melanoma, lentigo maligna subtype: a practical surgical technique. Arch Facial Plast Surg 2001;3:202-6.
54. Cohen LM. Lentigo maligna and lentigo maligna melanoma. J Dermatol 1995;33:913.
55. Conley J, Lattes R, Orr W. Desmoplastic malignant melanoma (a rare variant of spindle cell melanoma). Cancer 1971;28:914-36.
56. Reed JG, Leonard DD. Neurotropic melanoma: a variant of desmoplastic mela-noma. Am J Surg Pathol 1979;3:310-1.
57. Carlson JA, Dickersin GR, Sober AJ, Barnhill RL. Desmoplastic neurotropic melanoma, a clinicopathologic analysis of 28 cases. Cancer 1995;75:478-94.
58. Quinn MJ, Crotty KA, Thompson JG, Coates AS, O’Brien CJ, McCarthy WH.
Desmoplastic and desmoplastic neurotropic melanoma, experience with 280 patients. Cancer 1998;83:1128-35.
59. Fullen DR, Lowe L, Wang TS, Schwartz JL, Cimmino VM, Sondak VK, Johnson TM. Desmoplastic and neurotropic melanoma: analysis of 33 patients with lymphatic mapping and sentinel lymph node biopsy. Cancer 2003;100:598-604.
60. Chang AE, Karnell LH, Menck HR. The national cancer database report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. Cancer 1998;83:1664-78.
61. Chang P, Knapper WH. Metastatic melanoma of unknown primary. Cancer 1982;49:1106-11.
62. Norman J, Cruse CW, Wells KE, Saba HI, Reintgen DS. Metastatic melanoma with an unknown primary. Ann Plast Surg 1992;28:81-4.
63. Nasri S, Namazie A, Dulguerov P, Mickel R. Malignant melanoma of cervical and parotid lymph nodes with an unknown primary site. Laryngoscope 1994;104:
1194-8.
64. Santini H, Byers RM, Wolf PF. Melanoma metastatic to cervical and parotid nodes from an unknown primary site. Am J Surg 1985;150:510-2.
65. Jonk A, Kroon BBR, R°mke P, Maooi WJ, Hart AA, van Dongen JA. Lymph node metastasis from melanoma with an unknown primary site. Br J Surg 1990;77:665-8.
66. Bulkey GB, Cohen MH, Banks PM, Char DH, Ketcham AS. Long-term spontane-ous regression of malignant melanoma with visceral metastasis, report of a case with immunologic profile. Cancer 1975;36:485-94.
67. Ross MI, Stern SJ Mucosal melanomas. In: Balch CM, Houghton AN, Sober AJ,
826 Curr Probl Surg, November 2006
Soong SJ, editors. Cutaneous Melanoma. St. Louis, MO: Quality Medical Publishing; 2003.
68. Berthelsen A, Andersen AP, Jensen TS, Hansen HS. Melanomas of the mucosa in the oral cavity and the upper respiratory passages. Cancer 1984;54:907-12.
69. Hoyt DJ, Jordan T, Fisher SR. Mucosal melanoma of the head and neck. Arch Otolaryngol Head Neck Surg 1989;115:1096-9.
70. Manolidis S, Donald PJ. Malignant mucosal melanoma of the head and neck:
review of the literature and report of 14 patients. Cancer 1997;80:1373-86.
71. Patel SG, Prasad ML, Escrig M, Singh B, Shaha AR, Kraus DH, et al. Primary mucosal malignant melanoma of the head and neck. Head Neck 2002;24:247-57.
72. Kato T, Takematsu H, Tomita Y, Takahash M, Abe R. Malignant melanoma of mucous membranes. Arch Dermatol 1987;123:216-20.
73. Stern SJ, Guillamondegui OM. Mucosal melanoma of the head and neck. Head Neck 1991;13:22-7.
74. Batsakis JG, Regezi JA, Solomon AR, Rice DH. The pathology of head and neck tumors: mucosal melanoma, part 13. Head Neck Surg 1982;4:404-18.
75. Lee SP, Shimizu KT, Tran LM, Juillard G, Calcaterra TC. Mucosal melanoma of the head and neck: the impact of local control on survival. Laryngoscope 1994;104:121-6.
76. Koh HK, Miller DR, Geller AC, Clapp RW, Mercer MB, Lew RA. Who discovers melanoma? Patterns from a population-based survey. J Am Acad Dermatol 1992;26:914-9.
77. Schwartz JL, Wang TS, Hamilton TA, Clapp RW, Mercer MB, Lew RA. Thin primary cutaneous melanomas: associated detection patterns, lesion characteristics, and patient characteristics. Cancer 2002;95:1562-8.
78. Beardmore GL, Cavis NC. Multiple primary cutaneous melanomas. Arch Dermatol 1975;111:603-9.
79. Kang S, Barnhill RL, Mihm MC Jr, Sober AJ. Multiple primary cutaneous melanomas. Cancer 1992;70:1911-6.
80. Johnson TM, Hamilton T, Lowe L. Multiple primary melanomas. J Am Acad Dermatol 1998;39:422-7.
81. Moseley HS, Giuliano AE, Storm FK, Clark WH, Robinson DS, Morton DL.
Multiple primary melanoma. Cancer 1979;43:939-44.
82. American Academy of Dermatology Melanoma/skin cancer: you can recognize the signs. AAD patient handout. Evanston, IL: American Academy of Dermatology;
1986.
83. McGovern TW, Litaker MS. Clinical predictors of malignant pigmented lesions, a comparison of the Glasgow seven-point checklist and the American Cancer Society’s ABCDs of pigmented lesions. J Dermatol Surg Oncol 1992;18:22-6.
84. MacKie RM. Clinical recognition of early invasive melanoma. BMJ 1990;301:1005-6.
85. Rigel DS, Friedman RJ, Kopf AW, Polsky D. ABCDE—an evolving concept in the early detection of melanoma. Arch Dermatol 2005;141:1032-4.
86. Abbasi NR, Shaw HM, Rigel DS, Friedman JL, McCarthy WH, Osman I, et al.
Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA 2004;292:2771-6.
87. Grob JJ, Bonerandi JJ. The “ugly duckling”sign: identification of the common
characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol 1998;134:103-4.
88. Stadelmann WK, McMasters K, Digenis AG, Reintgen DS. Cutaneous melanoma of the head and neck: advances in evaluation and treatment. Plast Reconstr Surg 2000;05:2105-26.
89. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncol-ogy, v. 2.2005, Melanoma. Rockledge PA: NCCN, Inc.; 2005. Visit www.nccn.org for recent updates. Accessed December 13, 2005.
90. Johnson TM, Bradford CR, Gruber SB, Sondak VK, Schwartz JL. Staging workup, sentinel node biopsy, and follow-up tests for melanoma. Arch Dermatol 2004;140:107-13.
91. Ardizzoni A, Grimaldi A, Repetto L, Bruzzone M, Sertoli MR, Rosso R. Stage I-II melanoma: the value of metastatic work-up. Oncology 1987;44:87-9.
92. Khansur T, Sanders J, Das SK. Evaluation of staging workup in malignant melanoma. Arch Surg 1989;124:847-9.
93. Wang TS, Johnson TM, Cascade PN, Redman BG, Sondak VK, Schwartz JL.
Evaluation of staging chest radiographs and serum lactate dehydrogenase for localized melanoma. J Am Acad Dermatol 2004;51:399-405.
94. Buzaid AC, Sandler AB, Mani S, Curtis AM, Poow J, Bolognia JL, et al. Role of computed tomography in the staging of primary melanoma. J Clin Oncol 1993;11:638-43.
95. Curtis AM, Ravin CE, Deering TF, Putman CE, McCloud TC, Greenspan RH. The efficacy of full-lung tomography in the detection of early metastatic disease from melanoma. Radiology 1982;144:27-9.
96. Au FC, Maier WP, Malmud LS, Goldman LI, Clark WH Jr. Preoperative nuclear scans in patients with melanoma. Cancer 1984;53:2095-7.
97. Roth JA, Eilber FR, Bennett LR, Morton DL. Radionuclide photoscanning:
usefulness in preoperative evaluation of melanoma patients. Arch Surg 1975;110:1211-2.
98. Johnson TM, Chang A, Redman B, Rees R, Bradford CR, Riba M, et al.
Management of melanoma with a multidisciplinary melanoma clinic model. J Am Acad Dermatol 2000;42:820-6.
99. Basler GC, Fader DJ, Yahanda A, Sondak VK, Johnson TM. The utility of fine needle aspiration in the diagnosis of melanoma metastatic to lymph nodes. J Am Acad Dermatol 1997;36:403-8.
100. Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001;19:3622-34.
101. Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001;19:3635-48.
102. Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg 1970;172:902-8.
103. Balch CM, Wilkerson JA, Murad TM, Soong SJ, Ingalls AL, Maddox WA. The prognostic significance of ulceration of cutaneous melanoma. Cancer 1980;45:3012-7.
104. Azzola MF, Shaw HM, Thompson JF. Tumor mitotic rate is a more powerful
828 Curr Probl Surg, November 2006
prognostic indicator than ulceration in patients with primary cutaneous melanoma, an analysis of 3661 patients from a single center. Cancer 2003;97:1488-98.
105. Ostmeier H, Fuchs B, Otto F, Mawick R, Lippold A, Krieg V, et al. Can immunohistochemical markers and mitotic rate improve prognostic precision in patients with primary melanoma? Cancer 1999;85:2391-99.
106. Buzaid AC, Tinoco LA, Jendiroba D, Tu ZN, Lee JJ, Legha SS, et al. Prognostic value of size of lymph node metastases in patients with cutaneous melanoma. J Clin Oncol 1995;13:2361-8.
107. Buzaid AC, Ross MI, Balch CM, Soong S, McCarthy WH, Tinoco L, et al. Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol 1997;15:1039-51.
108. Harrist T, Rigel D, Day C Jr, Sober AJ, Lew RA, Rhodes AR, et al. Microscopic satellites are more highly associated with regional lymph node metastases than with primary melanoma thickness. Cancer 1984;53:2183-7.
109. Morton DL, Davtyan DG, Wanek LA, Foshag ILA, Cochran AJ. Multivariate analysis of the relationship between survival and the microstage of primary melanoma by Clark level and Breslow thickness. Cancer 1993;71:3737-43.
110. Brand CU, Ellwanger U, Stroebel W, Meier F, Schlagenhauff B, Rassner G, et al.
Prolonged survival of 2 years or longer for patients with disseminated melanoma, an analysis of related prognostic factors. Cancer 1997;79:2345-53.
111. Deichmann M, Benner A, Bock M, Jackel A, Uhl K, Waldmann V, et al.
S100-Beta, melanoma-inhibiting activity, and lactate dehydrogenase discriminate progressive from nonprogressive American Joint Committee on Cancer stage IV melanoma. J Clin Oncol 1999;17:1891-6.
112. Eton O, Legha SS, Moon TE, Buzaid AC, Papadopoulos NE, Plager C, et al.
Prognostic factors for survival of patients treated systemically for disseminated melanoma. J Clin Oncol 1998;16:1103-11.
113. Sirott MN, Bajorin DF, Wong GY, Tao Y, Chapman PB, Templeton MA, et al.
Prognostic factors in patients with metastatic malignant melanoma, a multivariate analysis. Cancer 1993;72:3091-8.
114. Barth A, Wanek LA, Morton DL. Prognostic factors in 1,521 melanoma patients with distant metastases. J Am Coll Surg 1995;181:193-201.
115. Garbe C, B°ttner P, Bertz J, Burg G, d’Hoedt B, Drepper H, et al. Primary cutaneous melanoma: prognostic classification of anatomic location. Cancer 1995;75:2492-8.
116. Fisher SR. Cutaneous malignant melanoma of the head and neck. Laryngoscope 1989;99:822-36.
117. Fisher SR, Seigler HF, George SL. Therapeutic and prognostic considerations of head and neck melanoma. Ann Plast Surg 1992;28:78-80.
118. Handley WS. The pathology of melanotic growths in relation to their operative treatment. Lancet 1907;1:996-1003.
119. Breslow A, Macht SD. Optimal size of resection for thin cutaneous melanoma. Surg Gynecol Obstet 1997;145:691-2.
120. Veronesi U, Adamus J, Bandiera DC, Brennhovd O, Caceres E, Cascinelli N, et al.
Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities. Cancer 1982;49:2420-30.
121. Veronesi U, Cascinelli N, Adamus J, Balch C, Bandiera D, Barchuk A, et al. Thin
stage I primary cutaneous malignant melanoma: comparison of excision with margins of 1 or 3 cm. N Engl J Med 1998;318:1159-62.
122. Balch CM, Soong SJ, Smith T, Ross MI, Urist MM, Karakousis CP, et al.
Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas. Ann Surg Oncol 2001;8:101-8.
123. Thomas JM, Newton-Bishop J, A’Hern R, Coombes G, Timmons M, Evans J, et al.
Excision margins in high-risk melanoma. N Engl J Med 2004;350:757-66.
124. Johnson TM, Sondak VK. Melanoma margins: the importance and need for more evidence-based trials. Arch Dermatol 2004;140:1148-50.
125. Heaton KM, Sussman JJ, Gershenwald JE, Lee JR, Reintgen DS, Mansfield PF, et al. Surgical margins and prognostic factors in patients with thick (⬎4mm) primary melanomas. Ann Surg Oncol 1998;5:322-8.
126. Barzilai DA, Singer ME. The potential impact on melanoma mortality of reducing rates of suboptimal excision margins. J Invest Dermatol 2003;120:1067-72.
127. Kenady DE, Brown BE, McBride CM. Excision of underlying fascia with a primary malignant melanoma: effect on recurrence and survival rates. Surgery 1982;92:615-8.
128. Johnson TM, Smith JW II, Nelson BR, Chang A. Current therapy for cutaneous melanoma. J Am Acad Dermatol 1995;32:689-707.
129. Johnson TM, Headington JT, Baker SR, Lowe L. Usefulness of the staged excision for lentigo maligna and lentigo maligna melanoma: the “square” procedure. J Am Acad Dermatol 1997;37:758-64.
130. Lent WM, Ariyan S. Flap reconstruction following wide local excision for primary
130. Lent WM, Ariyan S. Flap reconstruction following wide local excision for primary