04 Malignant Skin Lesions

For patients with ulcerated t3 lesions the predicted

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Unformatted text preview: learly associated with a worse prognosis than thin melanomas: the 5-year survival rate is 89% for patients with nonulcerated T2 lesions and 77.4% for those with ulcerated lesions. For patients with ulcerated T3 lesions, the predicted 5-year survival rate is 63%. For node-negative patients with thick (> 4 mm) lesions, the 5year survival rate is 67.4%; this figure drops to 45.1% if the lesion is ulcerated.34 Stage III melanoma Stage III melanoma is characterized by the presence of nodal metastases (micrometastases or macrometas- T N M 0 Tis N0 M0 IA T1a N0 M0 IB T1b, T2a N0 M0 IIA T2b, T3a N0 M0 IIB T3b, T4a N0 M0 IIC T4b N0 M0 IIIA T1–4a N1a, N2a M0 IIIB T1–4b T1–4a Any T N1a, N2a N1b, N2b N2c M0 M0 M0 IIIC T1–4b Any T N1b, N2b N3 M0 M0 IV Any T Any N M1 © 2006 WebMD, Inc. All rights reserved. 3 BREAST, SKIN, AND SOFT TISSUE Table 5—5-Year Melanoma Survival Correlated with AJCC Stage Stage IA TNM 5-Year Survival (%) T1a N0 M0 77.4 78.7 T3b N0 M0 63.0 67.4 T4b N0 M0 45.1 T1–4a N1a M0 69.5 63.3 T1–4b N1a M0 52.8 T1–4b N2a M0 49.6 T1–4a N1b M0 59.0 T1–4a N2b M0 46.3 T1–4b N1b M0 29.0 T1–4b N2b M0 24.0 Any T N3 M0 26.7 Any T any N M1a 18.8 Any T any N M1b 6.7 Any T any N M1c IIIA T2b N0 M0 T1–4a N2a M0 IIC 89.0 T4a N0 M0 IIB 90.9 T3a N0 M0 IIA T1b N0 M0 T2a N0 M0 IB 95.3 9.5 IIIB IIIC IV Initial Evaluation For initial evaluation of patients with thin melanomas (< 1 mm), no routine laboratory or radiologic tests are recommended. For patients with thicker melanomas (≥ 1 mm), some clinicians recommend a chest x-ray. For patients with stage III disease, chest radiography or computed tomography of the chest, the abdomen, and the pelvis may be performed and are indicated for any signs or symptoms of metastases. If inguinal lymphadenopathy is apparent, pelvic CT should be performed to assess the iliac lymph nodes.38 For patients with stage IV disease, chest radiography should be performed and serum LDH levels obtained. Magnetic resonance imaging of the brain and CT of the chest, the abdomen, and the pelvis should be performed to address any signs or symptoms of metastases and before any therapy is initiated. Any other imaging done will be guided by protocol if the patient is enrolled in a clinical trial.38 Treatment Surgical treatment of stage I and II melanoma Margins of excision. Surgical excision remains the mainstay of treatment for melanoma. The width of the recommended surgical margin depends on the thickness of the lesion and has been well defined by a series of prospective randomized clinical trials.39 According to most current recommendations, a 0.5 cm margin is adequate for melanoma in situ, a 1 cm margin is suggested for melanomas thinner than 1.0 mm, a 1 or 2 cm margin should be obtained for melanomas between 1 and 2 mm thick, and a 2 cm margin is required for melanomas thicker than 2 mm.39 ACS Surgery: Principles and Practice 4 Malignant Skin Lesions — 7 Sentinel lymph node biopsy. An important issue in the surgical management of melanoma is the use of sentinel lym...
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This note was uploaded on 03/21/2011 for the course ONC 01 taught by Professor Dzodic during the Spring '11 term at Multimedia University, Cyberjaya.

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