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Feature Articles: Melanoma

Guest Editor's Note:
John B. Harris, M.D.
Section of Plastic and Reconstructive Surgery
Mayo Clinic Jacksonville
 

This issue of Jacksonville Medicine offers an overview of issues related to the management of the patient with primary cutaneous melanoma. In years past the subject of "what's new in melanoma management" focused primarily on controversy relating to margins of resection of the primary tumor, elective lymph node dissection for intermediate thickness melanoma, and perhaps discussion regarding adjuvent and adjunctive therapy measures. Recently, the development of the concept of a sentinel lymph node biopsy, more sensitive pathology assay techniques, along with reports of possible benefit with interferon alpha-2b as adjuvent therapy have changed this discussion dramatically with development of alternative management pathways. The impact of these new techniques and treatments on overall melanoma survival remains to be evaluated and will certainly be an area of intense interest.

In an area such as melanoma where changes and advances in treatment have come so slowly, any glimmer of hope for improved survival is greeted with open arms. However, not to be overlooked by all of the attention to the treatment of the patients with high risk melanoma is the importance of improving screening programs for melanoma. A potentially lethal malignancy that can be diagnosed by observation and physical exam should be given the highest priority for screening programs. Early detection is the single most important factor in providing for a cure for melanoma. Certainly an evaluation of health care resource expenditures would justify improved screening and biopsy programs. A higher index of suspicion by all physicians, regardless of specialty, for patients with darkly pigmented skin lesions along with more frequent biopsy would likely have a tremendous impact on mortality rates that we only can hope for now with surgical, pathology, and chemotherapy treatment advances.

Jacksonville Medicine / October, 1999

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