51. Berman, Russell. Skin Cancer: Surgical Management of Melanoma. NY Cancer Institute, 4 Aug. 2011. Web. <http://www.youtube.com/watch?v=j50ULW7vXa0>.
L: Three levels of treatment:
o Local
o Regional
o Distant or systemic metastases
Get your pathology report
· determines the surgical intervention
· the stage of the tumors
· deep, thickness
· thickness of the melanoma is crucial to how it is treated
· presence of ulceration (skin breaks down, such as bleeding)
· mitotic rate tells you what to do also
I: The pathology report is significant to understand so the oncologist team knows what is best for you.
Local (wide excision)
· to remove the tumor cells, because melanoma does not go in a straight line
· to reduce the cosmetic damage and muscle damage
· Randomized trial done: less than 1m thick, we take a 1 cm excision, 1-2 mm, we take a 1-2 cm, 2-4 mm, we take a 2 cm margin excision compared to 1906, they took the 2 in excision
· Examples of how excision is closed
I: Russell Berman shows significant gain over the last 100 years in the wide excision. I am surprised how exact they can be to get the tumor.
Regional (Lymph Node)
· Surgery or removal hasn’t meant you will live longer, so much question regarding this process
· If the node is negative, then the surgeon is done, if it is positive, then it is standard to look at again to see if it spread
· The thicker the melanoma the more concerning it is
· Offered to anybody with melanoma of 1mm or larger, but meant for larger mm
I: Difficult to comprehend. The thicker the melanoma, more likely it is called regional. It seems like we have less success with this melanoma using surgery, almost sounded like hit and miss if we stop the spreading effectively the first time.
Systemic
· Spreading to the brain, lungs, etc
· Typically don’t think of surgery, but can go after each part using surgery
I: Didn’t speak much on it, because another speaker at the conference was going to speak on it.
Multidisciplinary Treatment and follow up
· Surgeons, Dermatologist, Medical Oncologist, Radiology Oncologist
I: It is important to see there are many different roles in helping a patient. This list does not include the assistants such as the radiologist.
All skin cancers are treatable. Surgery is the first option usually.
Sometimes the biopsy (the scraping of it to test it) removes it, “doctors use surgery, radiation therapy, topical chemotherapy, photodynamic therapy (treatment with drugs that become active when exposed to light), or a combination of methods to treat basal and squamous cell skin cancers.”
I: There is no one thing a team can do. It is whatever works. Surgery is the first option usually though.
Moh’s surgery: thin layer is removed
Cryosurgery: freezes it
Laser surgery: destroy the skin cancer
Electrodesiccation: scraping and burning
I: There are a number of additional treatments depending on the situation.
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