Management of Thick Melanomas

Primary Melanoma Management

For a 5mm thick melanoma, a wide excision with 3cm margins is the appropriate surgical approach in the absence of systemic disease, as recommended by the British Journal of Dermatology 1, 2
Melanomas with Breslow thickness >4mm should have excision margins of 2-3cm, with 3cm being preferred based on evidence showing increased locoregional recurrence with narrower margins, according to the British Journal of Dermatology 3, 2
The excision should include the primary tumor and surrounding normal-appearing skin to ensure complete removal of all malignant cells, as stated in the British Journal of Cancer 4, 5

Complete inguinal node dissection is indicated if there is no evidence of systemic metastasis, as recommended by the British Journal of Cancer and Annals of Oncology 4, 6
Surgical dissection of involved nodes is the standard treatment for patients presenting with regional node involvement, according to the British Journal of Cancer 4, 5
The number of involved nodes is the most important prognostic factor for patients with locoregional node involvement, as stated in the British Journal of Cancer 4
Sentinel lymph node biopsy is not indicated when nodes are clinically palpable, as these patients should proceed directly to complete lymph node dissection, as recommended by the British Journal of Dermatology and Journal of the National Comprehensive Cancer Network 3, 7

Multiple lung metastases should NOT be surgically excised as soon as possible, making this statement false, according to Annals of Oncology and British Journal of Dermatology 6, 8
For patients with multiple metastatic sites, systemic therapy rather than surgical excision is the appropriate approach, as recommended by the Journal of the National Comprehensive Cancer Network and Annals of Oncology 7, 6

Chemotherapy for melanoma is indeed primarily palliative, and surgical therapy is preferred if there is no evidence of metastatic disease beyond the inguinal region, as stated in the British Journal of Dermatology and Annals of Oncology 8, 6
Dacarbazine has been the standard chemotherapy but offers only palliative benefit, according to the British Journal of Dermatology 8

If the nodes do not contain metastatic disease but are simply reactive, the 5-year survival rate would still be 50% or less for a 5mm thick melanoma, making this statement true, as recommended by the British Journal of Dermatology 1, 2
Melanomas with Breslow thickness >4mm have approximately 50% 5-year survival rate even with negative nodes, according to the British Journal of Dermatology 2
The prognosis worsens significantly with increasing tumor thickness and the presence of nodal metastases, as stated in the British Journal of Cancer 4
Breslow thickness is the most powerful prognostic factor for primary melanoma, and 5mm represents a very thick, high-risk tumor, according to the British Journal of Cancer 5

Inadequate surgical margins for thick melanomas can lead to increased local recurrence, as stated in the British Journal of Dermatology 3
Failure to perform complete lymph node dissection when nodes are clinically positive can result in inadequate staging and treatment, according to the British Journal of Cancer and Annals of Oncology 4, 6
Relying solely on chemotherapy without appropriate surgical management of the primary tumor and regional nodes when no distant metastases are present, as recommended by Annals of Oncology and Journal of the National Comprehensive Cancer Network 6, 7