Tratamiento quirúrgico del melanoma primario: consideraciones prácticas

Abstract

The treatment of choice for localized primary melanoma is excisional biopsy followed by margin expansion based on the Breslow depth. Partial biopsies may be appropriate in the initial study of extensive melanomas or in complex locations. The recommended margins for melanoma in situ are 0.5-1 cm, although it seems that, especially in the lentiginous type, they are more convenient the closer to the centimeter. For invasive melanomas, margins of 1 cm in Breslow depth < 1 mm, 1-2 cm in Breslow depth 1-2 mm, and 2 cm in Breslow depth > 2 mm are recommended. Single-stage excision can be considered when selective sentinel node biopsy is rejected, but it is not currently supported by the guidelines. In those cases in which the precision of the complete excision of the lesion must be maximized, mainly in facial lentigo maligna, margin control techniques are recommended. On the other hand, acral melanomas, both subungual, palmar or plantar, require special management given their anatomical complexity.