MANAGEMENT OF STAGE-I MALIGNANT-MELANOMA

BACKGROUND. Because of the rising incidence of melanoma, dermatologists are increasingly responsible for diagnosing and managing patients with this cutaneous malignancy. Fortunately, with the increased awareness and emphasis on early detection, most patients will present with tumors that have not yet spread beyond their primary focus in the skin (ie, Stage I). Dermatologists must, therefore, be fully versed in the diagnosis and management of Stage I melanoma. OBJECTIVE. This review article focuses on the most important issues related to the diagnosis and management of Stage I mel anoma. An emphasis will be placed on surgical management. RESULTS. The mainstay of therapy for most patients with Stage I melanoma is surgery. The important principles of diagnostic biopsy and surgical excision will be discussed. There are several additional modalities that may be useful as adjuvants to surgical therapy or as primary therapy in situations when surgery is not feasible. Those include elective lymph node dissection, hyperthermic isolation limb perfusion, radiotherapy, cryotherapy, chemotherapy, and immunotherapy. These will all be reviewed. CONCLUSIONS. With a thorough understanding of the important principles and controversies related to the management of Stage I melanoma, dermatologists can effectively manage the growing number of patients with this malignancy.