Current Controversies in Melanoma Treatment | Journal CME Article-Journal CME Article: Current Controversies in Melanoma Treatment Article

Journal CME Article: Current Controversies in Melanoma Treatment Article

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Recent advances in melanoma treatment have stirred discussion and innovation within the medical community. A new staging system has been refined, and there is ongoing debate about the need for wide excision margins, lymphadenectomies are increasingly limited to cases of regional recurrence following a positive sentinel node biopsy, and rapid advancements in immunotherapy and targeted therapy options have occurred. This has significant implications for plastic surgeons, who are at the fore of evolving treatment options and controversies.<br /><br />Margins for melanoma have been under scrutiny for decades. Current guidelines suggest margins of 1 cm for tumors less than 1 mm thick, 1-2 cm for tumors between 1-2 mm, and 2 cm for tumors over 2 mm. Contemporary studies like the MelMarT trial are seeking to further understand the implications of these surgical margins, especially in the context of current immunotherapy practices.<br /><br />In terms of reconstruction, narrow surgical margins favor the use of keystone flaps—particularly useful for limb reconstructions and avoiding skin grafts. Alternative surgical approaches have emerged for subungual melanoma, opting for digit-sparing surgery instead of amputation, with considerations for patient satisfaction and functional outcomes.<br /><br />Sentinel node biopsies remain a cornerstone for staging and management of melanoma, with new technologies aimed at improving their accuracy. While completion lymphadenectomy post-positive biopsy is declining, novel techniques in lymphatic reconstruction are being explored to prevent lymphedema.<br /><br />Additionally, minimally invasive methods for managing in-transit melanoma, like intralesional interleukin-2 therapies, are showing high success rates and durable responses. These options are becoming preferred for their efficacy and patient outcomes.<br /><br />In conclusion, as melanoma treatment evolves, plastic surgeons are integral in implementing and advancing both surgical and non-surgical interventions that positively impact patient survival and quality of life.

Keywords

melanoma treatment

staging system

wide excision margins

lymphadenectomy

immunotherapy

targeted therapy

keystone flaps

sentinel node biopsy

lymphatic reconstruction

intralesional interleukin-2