NCCN Guidelines for Patients® | Melanoma - page 37

NCCN Guidelines for Patients
®
Melanoma, Version 1.2014
35
4
Overview melanoma treatments Surgery
When wider margins are removed, or when wide
excision is combined with lymph node surgery, general
anesthesia is often needed. General anesthesia is a
controlled loss of wakefulness from drugs. For lentigo
maligna melanoma, particularly on the face, different
types of surgery may be recommended to very
carefully examine the surgical margins.
A pathologist will examine the removed tissue with
a microscope to see if there is any cancer in the
surgical margins. If the margins have cancer, you may
need more surgery. A positive margin means there
is cancer in the surgical margin. A negative margin
means there is no cancer in the surgical margin.
Sentinel lymph node biopsy
Based on the features of the primary melanoma tumor,
there may be an increased risk of microscopic spread
of melanoma cells to nearby (regional) lymph nodes.
These lymph nodes are often found in nodal basins.
Nodal basins are groups or clusters of lymph nodes
found in certain parts of the body, such as the neck,
armpit, and groin area. Microscopic spread to a lymph
node cannot be detected by touch or by imaging tests.
If the risk is high enough, your doctor may recommend
a sentinel lymph node biopsy. This surgery involves
injecting a special dye into the skin near the primary
tumor. The dye follows the path lymph takes when it
leaves the tumor. Your doctor will measure movement
of the dye to find the sentinel lymph node—the first
lymph node to which lymph, and possibly a cancer
cell, travels. The sentinel lymph node will then be
removed through a small surgical cut in the skin so a
pathologist can test it for melanoma cells.
Lymph node dissection
Your doctor may perform a lymph node dissection if
the sentinel lymph node biopsy or other tests show
that cancer cells have spread to a lymph node basin.
A lymph node dissection is surgery that removes all
the lymph nodes in the nodal basin. This surgery is
done with general anesthesia—a controlled loss of
wakefulness from drugs.  
Figure 10. Area of wide excision
with a 1.5 cm margin
A wide excision is surgery that
removes the entire melanoma
tumor along with some normal-
looking tissue around its edge.
The normal-looking tissue is called
the surgical margin.
Illustration Copyright © 2014 Nucleus Medical Media, All rights reserved.
Chart 2. Surgical margins for melanoma
T
Tumor thickness Surgical margin
Tis
In situ
0.5–1.0 cm
T1
≤1.0 mm
1.0 cm
T2
1.01–2.0 mm 1.0–2.0 cm
T3
2.01–4.0 mm 2.0 cm
T4
>4 mm
2.0 cm
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