University of Tasmania, Launceston, TAS
Melanoma Institute Australia, Sydney, NSW.
Med J Aust. 2018 Feb 19;208(3):137-142. doi: 10.5694/mja17.00278.
Definitive management of primary cutaneous melanoma consists of surgical excision of the melanoma with the aim of curing the patient. The melanoma is widely excised together with a safety margin of surrounding skin and subcutaneous tissue, after the diagnosis and Breslow thickness have been established by histological assessment of the initial excision biopsy specimen. Sentinel lymph node biopsy should be discussed for melanomas ≥ 1 mm thickness (≥ 0.8 mm if other high risk features) in which case lymphoscintigraphy must be performed before wider excision of the primary melanoma site. The 2008 evidence-based clinical practice guidelines for the management of melanoma (http://www.cancer.org.au/content/pdf/HealthProfessionals/ClinicalGuidelines/ClinicalPracticeGuidelines-ManagementofMelanoma.pdf) are currently being revised and updated in a staged process by a multidisciplinary working party established by Cancer Council Australia. The guidelines for definitive excision margins for primary melanomas have been revised as part of this process. Main recommendations: The recommendations for definitive wide local excision of primary cutaneous melanoma are: melanoma in situ: 5-10 mm margins invasive melanoma (pT1) ≤ 1.0 mm thick: 1 cm margins invasive melanoma (pT2) 1.01-2.00 mm thick: 1-2 cm margins invasive melanoma (pT3) 2.01-4.00 mm thick: 1-2 cm margins invasive melanoma (pT4) > 4.0 mm thick: 2 cm margins Changes in management as a result of the guideline: Based on currently available evidence, excision margins for invasive melanoma have been left unchanged compared with the 2008 guidelines. However, melanoma in situ should be excised with 5-10 mm margins, with the aim of achieving complete histological clearance. Minimum clearances from all margins should be assessed and stated. Consideration should be given to further excision if necessary; positive or close histological margins are unacceptable.
皮肤原发性黑素瘤的明确治疗方法包括手术切除黑素瘤，以治愈患者。在通过初始切除活检标本的组织学评估确定诊断和 Breslow 厚度后，广泛切除黑素瘤以及周围皮肤和皮下组织的安全边界。对于厚度≥1 毫米（如果存在其他高危特征，则为≥0.8 毫米）的黑素瘤，应讨论前哨淋巴结活检，在此情况下，必须在广泛切除原发性黑素瘤部位之前进行淋巴闪烁显像。2008 年澳大利亚癌症委员会成立的多学科工作组正在分阶段修订和更新皮肤黑素瘤管理的循证临床实践指南（http://www.cancer.org.au/content/pdf/HealthProfessionals/ClinicalGuidelines/ClinicalPracticeGuidelines-ManagementofMelanoma.pdf）。作为这一过程的一部分，对原发性黑素瘤明确切除边界的指南进行了修订。主要建议：对于皮肤原发性黑素瘤的明确广泛局部切除的建议如下：原位黑素瘤：5-10 毫米边界侵袭性黑素瘤（pT1）≤1.0 毫米厚：1 厘米边界侵袭性黑素瘤（pT2）1.01-2.00 毫米厚：1-2 厘米边界侵袭性黑素瘤（pT3）2.01-4.00 毫米厚：1-2 厘米边界侵袭性黑素瘤（pT4）>4.0 毫米厚：2 厘米管理上的变化：根据目前的证据，与 2008 年指南相比，侵袭性黑素瘤的切除边界保持不变。然而，原位黑素瘤应切除 5-10 毫米边界，以实现完全的组织学清除。应评估并报告所有边界的最小清除距离。如有必要，应考虑进一步切除；阳性或接近的组织学边界是不可接受的。
