04 Malignant Skin Lesions

The following ve factors are commonly cited as

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Unformatted text preview: cts (e.g., fatigue, neutropenia, headache, fever, and chills) with interferon therapy.66 Treatment of stage IV melanoma Metastasectomy. There is a large body of literature supporting resection of metastases from melanoma.The following five factors are commonly cited as predictive of survival after metastasectomy: (1) the initial disease stage, (2) the disease-free interval after treatment of the primary melanoma, (3) the initial site of metastasis, (4) the extent of metastatic disease (single versus multiple sites), and (5) the ability to achieve complete resection.57 In well-selected patients, this procedure can yield a reasonable likelihood of survival: a 1995 series reported a 5-year survival rate of 27% in all patients after pulmonary metastasectomy and a rate of 39% in patients with a single metastatic lesion.68 More modest benefits have been observed after resection of metastases to the GI tract: a 1996 series reported a median survival of 44.5 months in patients in whom a complete resection was achieved, compared with a median survival of 4 weeks in those in whom complete resection could not be achieved.69 The five aforementioned factors are of critical importance in patient selection for metastasectomy.To improve patient selection for curative procedures, surgeons often treat patients with a single-site asymptomatic metastasis by administering chemotherapy for 2 to 3 months before considering resection, the aim being to see whether the disease stabilizes or additional metastases develop.57 If there is a response to treatment or the disease stabilizes with no evidence of further metastases, they proceed with resection.57 It is extremely important to perform high-quality imaging before considering resection of metastases.The use of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) may help detect occult metastatic disease more accurately. A 2004 comparison of FDG-PET with conventional imaging in patients with stage IV melanoma reported a sensitivity and specificity of 76% and 87% for conventional imaging, 79% and 87% for FDG-PET, and 88% and 91% for conventional imaging combined with FDG-PET.70 With FDG-PET, as with any other imaging modality, appropriate use depends on a clear understanding of its capabilities and limitations. Another important indication for metastasectomy is palliation; the vast majority of patients with stage IV melanoma will not be candidates for curative-intent metastasectomy.The goal of a palliative pro- © 2006 WebMD, Inc. All rights reserved. ACS Surgery: Principles and Practice 3 BREAST, SKIN, AND SOFT TISSUE cedure is to control identifiable symptoms (e.g., GI bleeding or pain) caused by an advanced malignancy while minimizing morbidity.57 A thorough discussion should be held among the surgeon, the patient, and the family to address the goals and expected outcomes of the procedure, as well as its potential morbidity.71 Chemotherapy. To date, the rates of objective response to chemotherapy for melanoma have been somewhat disappointing. Darcarbazine (DTIC) is the only currently approved chemotherapeutic agent for melanoma, and it offers no more than marginal therapeutic benefit, with moderate side effects.72 Various...
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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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