MANAGEMENT OF STAGE-I MALIGNANT-MELANOMA

BACKGROUND. Because of the rising incidence of melanoma, dermatologist s are increasingly responsible for diagnosing and managing patients wi th this cutaneous malignancy. Fortunately, with the increased awarenes s and emphasis on early detection, most patients will present with tum ors that have not yet spread beyond their primary focus in the skin (i e, Stage I). Dermatologists must, therefore, be fully versed in the di agnosis and management of Stage I melanoma. OBJECTIVE. This review art icle focuses on the most important issues related to the diagnosis and management of Stage I mel anoma. An emphasis will be placed on surgic al management. RESULTS. The mainstay of therapy for most patients with Stage I melanoma is surgery. The important principles of diagnostic b iopsy and surgical excision will be discussed. There are several addit ional modalities that may be useful as adjuvants to surgical therapy o r as primary therapy in situations when surgery is not feasible. Those include elective lymph node dissection, hyperthermic isolation limb p erfusion, radiotherapy, cryotherapy, chemotherapy, and immunotherapy. These will all be reviewed. CONCLUSIONS. With a thorough understanding of the important principles and controversies related to the manageme nt of Stage I melanoma, dermatologists can effectively manage the grow ing number of patients with this malignancy.