Diagnosis and treatment of malignant melanoma arising from the skin of the female breast

Abstract

The treatment of malignant melanoma arising from the skin of the female breast poses many problems. We have routinely treated such melanomas with orthodox radical mastectomy, removing the entire breast in continuity with the intervening lymphatics and performing radical axillary dissection. The question arises as to the possibilities of altering this form of surgery. Can a more conservative procedure, such as removal of the skin in continuity with the intervening lymphatics and radical axillary dissection, be performed? This procedure would theoretically embrace the primary tenet of cancer surgery, that is, removal of the primary lesion and the surrounding tissue, the intervening lymphatics, and the first echelon of lymph nodes where metastases can occur. This less deforming procedure would be much more acceptable to the patient. At the other extreme is the problem of whether a more radical procedure should be performed such as extended radical mastectomy in which the internal mammary lymph node chain is also removed. It is our studied belief that surgical resection is the only form of treatment by which malignant melanoma can be cured. Radiation therapy and chemotherapy may produce palliation, but are not used by us as primary therapy. A retrospective analysis of eight patients with melanomas of the breast from a total of 2,824 patients with malignant melanoma seen at the Pack Medical Group is presented.