O'Rourke M G, Bourke C
Department of Surgery, Mater Misericordiae Adult Public Hospital, Brisbane, Queensland, Australia.
World J Surg. 1995 May-Jun;19(3):343-5. doi: 10.1007/BF00299154.
Wide local excision for melanoma with margins of 3 to 5 cm have been advocated in the literature for nearly 140 years. These reports have grouped all stages of melanoma rather than addressing primary early stage disease. Breslow first advocated limited excision margins for these tumors. We have been excising all thicknesses of melanoma with a limited margin (1.00-1.50 cm, mostly 1.00 cm) since 1975. We advocate a 1 cm excision margin irrespective of tumor thickness. Clark has shown that melanoma invades in a vertical fashion, and thus one would expect to be more generous in depth than in width on a pathologic basis. Two studies have shown that there is no difference in the increase in locoregional recurrence and no change in death rate from the disease with more conservative treatment margins. Excision of this lesion is not an office procedure. It should be performed meticulously in an operating room, preferably under light general anesthesia.
在近140年的文献中，一直提倡对黑色素瘤进行切缘为3至5厘米的广泛局部切除。这些报告将黑色素瘤的所有阶段归为一组，而不是针对早期原发性疾病。布雷斯洛首先主张对这些肿瘤采用有限的切除切缘。自1975年以来，我们一直以有限的切缘（1.00 - 1.50厘米，大多为1.00厘米）切除所有厚度的黑色素瘤。我们主张无论肿瘤厚度如何，切除切缘均为1厘米。克拉克已经表明黑色素瘤以垂直方式浸润，因此从病理学角度来看，人们会期望在深度上比宽度上更宽宏一些。两项研究表明，采用更保守的治疗切缘，局部区域复发的增加没有差异，该疾病的死亡率也没有变化。切除这种病变不是门诊手术。它应该在手术室中精心进行，最好在轻度全身麻醉下进行。
