Surgery is the first option for treating melanoma regardless of stage at presentation. We surveyed a representative sample of hospitals to evaluate management and quality of surgical indications for melanoma in Italy. At analysis, hospitals were grouped into high- or low-volume centers, with the population median of 25 diagnoses serving as the cut-off. Surgery for primary melanoma was similar between hospital groups. More high-volume centers were organized to perform sentinel node biopsy (91 vs. 56%). There were no major differences between high- and low-volume centers concerning the surgical approach to stage III and IV disease.

Keywords:
Melanoma, Surgery, Incision margins, Lymph node biopsy
1.
Karakousis CP, Balch CM, Urist MM, Ross MM, Smith TJ, Bartolucci AA: Local recurrence in malignant melanoma: long-term results of the multiinstitutional randomized surgical trial. Ann Surg Oncol 1996;3:446-452.
2.
Veronesi U, Cascinelli N: Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma. Arch Surg 1991;126:438-441.
3.
Heaton KM, Sussman JJ, Gershenwald JE, Lee JE, Reintgen DS, Mansfield PF, Ross MI: Surgical margins and prognostic factors in patients with thick (>4 mm) primary melanoma. Ann Surg Oncol 1998;5:322-328.
4.
Stage I melanoma of the skin: the problem of resection margins. W.H.O. Collaborating Centres for Evaluation of Methods of Diagnosis and Treatment of Melanoma. Eur J Cancer 1980;16:1079-1085.
5.
Whooley BP, Wallack MK: Surgical management of melanoma. Surg Oncol 1995;4:187-195.
6.
Ross MI: Surgery and other local-regional modalities for all stages of melanoma. Curr Opin Oncol 1994;6:197-203.
7.
Veronesi U, Cascinelli N, Adamus J, Balch C, Bandiera D, Barchuk A, Bufalino R, Craig P, De Marsillac J, Durand JC, et al: Thin stage I primary cutaneous malignant melanoma. Comparison of excision with margins of 1 or 3 cm. N Engl J Med 1988;318:1159-1162.
8.
Balch CM, Urist MM, Karakousis CP, Smith TJ, Temple WJ, Drzewiecki K, Jewell WR, Bartolucci AA, Mihm MC Jr, Barnhill R, et al: Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial. Ann Surg 1993;218:262-267.
9.
Cohn-Cedermark G, Rutqvist LE, Andersson R, Breivald M, Ingvar C, Johansson H, Jönsson PE, Krysander L, Lindholm C, Ringborg U: Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8-2.0 mm. Cancer 2000;89:1495-1501.
10.
Gillgren P, Drzewiecki KT, Niin M, Gullestad HP, Hellborg H, Månsson-Brahme E, Ingvar C, Ringborg U: 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial. Lancet 2011;378:1635-1642.
11.
Thomas JM, Newton-Bishop J, A'Hern R, Coombes G, Timmons M, Evans J, Cook M, Theaker J, Fallowfield M, O'Neill T, Ruka W, Bliss JM; United Kingdom Melanoma Study Group; British Association of Plastic Surgeons; Scottish Cancer Therapy Network: Excision margins in high-risk malignant melanoma. N Engl J Med 2004;350:757-766.
12.
Sladden MJ, Balch C, Barzilai DA, Berg D, Freiman A, Handiside T, Hollis S, Lens MB, Thompson JF: Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev 2009;4:CD004835.
13.
Lens MB, Nathan P, Bataille V: Excision margins for primary cutaneous melanoma: updated pooled analysis of randomized controlled trials. Arch Surg 2007;142:885-891.
14.
Haigh PI, DiFronzo LA, McCready DR: Optimal excision margins for primary cutaneous melanoma: a systematic review and meta-analysis. Can J Surg 2003;46:419-426.
15.
Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, Foshag LJ, Cochran AJ: Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392-399.
16.
Morton DL, Cochran AJ, Thompson JF, Elashoff R, Essner R, Glass EC, Mozzillo N, Nieweg OE, Roses DF, Hoekstra HJ, Karakousis CP, Reintgen DS, Coventry BJ, Wang HJ; Multicenter Selective Lymphadenectomy Trial Group: Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg 2005;242:302-311.
17.
Rossi CR, De Salvo GL, Trifirò G, Mocellin S, Landi G, Macripò G, Carcoforo P, Ricotti G, Giudice G, Picciotto F, Donner D, Di Filippo F, Montesco MC, Casara D, Schiavon M, Foletto M, Baldini F, Testori A: The impact of lymphoscintigraphy technique on the outcome of sentinel node biopsy in 1,313 patients with cutaneous melanoma: an Italian Multicentric Study (SOLISM-IMI). J Nucl Med 2006;47:234-241.
18.
Karakousis CP: Ilioinguinal lymph node dissection. Am J Surg 1981;141:299-303.
19.
Testori A, Rutkowski P, Marsden J, Bastholt L, Chiarion-Sileni V, Hauschild A, Eggermont AM: Surgery and radiotherapy in the treatment of cutaneous melanoma. Ann Oncol 2009;20(suppl 6):vi22-vi29.
20.
Testori A, Tosti G, Martinoli C, Spadola G, Cataldo F, Verrecchia F, Baldini F, Mosconi M, Soteldo J, Tedeschi I, Passoni C, Pari C, Di Pietro A, Ferrucci PF: Electrochemotherapy for cutaneous and subcutaneous tumor lesions: a novel therapeutic approach. Dermatol Ther 2010;23:651-661.
21.
Testori A, Faries MB, Thompson JF, Pennacchioli E, Deroose JP, van Geel AN, Verhoef C, Verrecchia F, Soteldo J: Local and intralesional therapy of in-transit melanoma metastases. J Surg Oncol 2011;104:391-396.
22.
Testori A, Verhoef C, Kroon HM, Pennacchioli E, Faries MB, Eggermont AM, Thompson JF: Treatment of melanoma metastases in a limb by isolated limb perfusion and isolated limb infusion. J Surg Oncol 2011;104:397-404.
23.
Mir LM, Gehl J, Sersa G, Collins CG, Garbay JR, Billard V, et al: Standard operating procedures of the electrochemotherapy: instructions for the use of bleomycin or cisplatin administered either systemically or locally and electric pulses delivered by the Cliniporator™ by means of invasive or non-invasive electrodes. EJC Suppl 2006;4:14-25.
24.
Mingozzi E, Fregosi S, Gandini S, Stanganelli I, Chiarion-Sileni V, Testori A: Melanoma Task Force (META) project in Italy: methodology. Dermatology 2013;226(suppl 1): 1-2.
© 2013 S. Karger AG, Basel
2013
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