Plastic and Reconstructive Surgery

Skip Navigation LinksHome > September 2013 - Volume 132 - Issue 3 > Managing Malignant Melanoma
Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31829ad411

Managing Malignant Melanoma

Dzwierzynski, William W. M.D.

Continued Medical Education
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In the September 2013 CME article by Dzwierzynski entitled “Managing Malignant Melanoma” (Plast Reconstr Surg. 2013;132:446e–460e), the legends for Figures 14 and 15 were reversed.

The correct legend for Figure 14 is as follows: (Above) Complete inguinal lymph node dissection on an 8-year-old patient with subungual melanoma (Fig. 5). The dissection is performed using a transverse skin incision. (Below) The femoral vessels are covered with a sartorius flap before skin closure.

The correct legend for Figure 15 is as follows: (Above) Adduction of the arm by an assistant facilitates axillary complete lymph node dissection. (Below) The complete lymph node dissection removes nodes from levels 1, 2, and 3. The nodal basin between the long thoracic nerve and the thoracodorsal nerve is completely dissected.

Plastic and Reconstructive Surgery. 133(3):761-762, March 2014.

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Learning Objectives: After reading this article, the participant should be able to: 1. Discuss the diagnosis, pathologic characteristics, and staging of cutaneous malignant melanoma. 2. Identify the indications for a sentinel lymph node biopsy. 3. Develop an operative plan including resection margins for melanoma and stages in performing a sentinel lymph node biopsy. 4. Recognize the signs of metastatic melanoma and discuss surgical and nonsurgical management options.

Summary: The incidence of melanoma is increasing worldwide. Melanomas represent 3 percent of all skin cancers but 65 percent of skin cancer deaths. Melanoma is now the fifth most common cancer diagnosed in the United States. Excisional biopsy should be performed for lesions suspicious for melanoma. The pathologist’s report provides essential information for surgical treatment; the most important information is the Breslow depth of the lesion. In addition to wide surgical excision of the primary lesion, sentinel lymph node biopsy is the standard of care for early identification of regional metastasis. Nodal metastasis found in the sentinel lymph node biopsy should be followed with a complete lymph node dissection. Although surgery remains the primary treatment of melanoma, recent advances in chemotherapy may offer further survival benefits to patients with metastatic disease.

©2013American Society of Plastic Surgeons


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