This may dictate choice of a wider margin, or further re-excision, where practicable. Pre-operative mapping of the extent of some lesions with confocal microscopy may be useful and is available in some centres.Īmelanotic melanoma can present significant difficulties for defining a margin with up to one third of subungual and nodular melanomas being non-pigmented. ![]() ![]() Alternatively, staged serial excision (also known as ‘slow Mohs’ surgery) may be utilised to achieve complete histological clearance of melanoma in situ/lentigo maligna. In these categories, the presence of atypical melanocytes at the margins of excision should be detected by comprehensive histological examination (including immunohistochemical staining) and followed by wider excision as appropriate. LM) and those with difficult-to-define margins (eg amelanotic and desmoplastic melanomas). These include melanomas occurring in severely sun-damaged skin (e.g. Some tumours may be incompletely excised despite using the above-recommended margins.Clinical question:What are the recommended safety margins for radical excision of primary melanoma?/In situ#Practice_point_8.Referral to a specialist melanoma centre or discussion in a multidisciplinary meeting should be considered for difficult or complicated cases. Pre-operative mapping of the extent of some lesions with confocal microscopy may be useful and is available in some centres. Some tumours may be incompletely excised despite using the above-recommended margins. Patients should be informed that surgical excision may be followed by wound infection, bleeding, haematoma, failure of the skin graft or flap, risk of numbness, a non-cosmetic scar, dehiscence and the possibility of further surgery.Clinical question:What are the recommended safety margins for radical excision of primary melanoma?/In situ#Practice_point_7.Multidisciplinary care of melanoma patients.Radiotherapy following resection of involved lymph nodes.Targeted therapies (MEK and BRAF inhibitors).Systemic drug therapy – unresectable stage IIIC and IV melanoma.Adjuvant systemic therapy – resected stage II and III melanoma.Summary of recommendations and practice points.Radiotherapy for patients with brain metastases.Systemic drug therapy for patients with brain metastases.Treatment of macroscopic nodal metastases.Treatment of satellite and in-transit metastases.Ideal frequency and duration of follow-up.Follow up after initial definitive treatment.Patients with in-transit/regional node disease (stage III).Patients with stage I and stage II melanomas.Investigations and follow-up – Introduction.Investigations and follow-up for melanoma patients. ![]() Continuation of HRT or oral contraceptive pill.Optimal management of pregnant women with melanoma.Management of pregnant women with melanoma.Pregnancy following a diagnosis of melanoma.Melanocytic tumour of unknown malignant potential.Sentinel node biopsy for desmoplastic melanoma.Management of primary desmoplastic and neurotropic melanomas.Primary desmoplastic neurotropic melanomas. ![]()
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