SURGICAL TREATMENT OF MELANOMA

In the department of Plastic Surgery numerous patients are treated yearly with a malignant melanoma, a subtype of malignant skin cancer. A close collaboration is established between our department and the department of Dermatology for optimal treatment. All patients are discussed on the staff meeting (multidisciplinary oncologic consult), which is held every 2 weeks for evaluation of the best possible treatment.

A malignant melanoma can arise spontaneously as a new lesion or develop from an existing mole or birthmark. The diagnosis is made by dermatoscopic examination of the lesion in combination with histologic examination of the skin biopsy. Prognostic important features are the thickness (in mm or Breslow-thickness) of the melanoma, presence of ulceration and the Clark-level. The thicker the melanoma, the bigger the chances are for distant metastasis either in the lymph nodes or in the organs. In every patient a staging procedure is performed, varying from ultrasound-examination, X-rays to CT-scan or PET-CT-scan.

The primary treatment of a malignant melanoma is surgery. In every case an additional skin resection has to be performed, depending on the Breslow-thickness and the presence of regression and/or ulceration. In our hospital we perform sentinel node biopsy for a Breslow-thickness of 1 mm or more. The sentinel node is the first lymph node that drains a certain skin area. The procedure is as follows: on the day of surgery a radio-active product is injected in the skin area of the melanoma, with a gamma camera the (sentinel) node is detected, this can be in the neck, the axilla or the groin, depending on the location of the melanoma. During surgery, patent blue is injected in the skin area of the melanoma for additional control as this also drains to the sentinel node. The surgeon is then able to perform a very precise sentinel node biopsy.

The additional treatment depends on the results of the sentinel node biopsy. This will be discussed in all cases in the multidisciplinary meetings between the plastic surgeon, the dermatologist and the medical oncologist.

Additional points of contact (representatives in Medical Oncologic Consult):

Department of Dermatology: Prof. Dr. Lieve Brochez tel.: +32 (0)9 332 2287.

Department of Medical Oncology: Dr. Natasha Verbeke tel.: +32 (0)9 332 2691.

Department of Plastic Surgery: Dr. Nathalie Roche tel.: +32 (0)9 332 32 78.