<< Back to the abstract archive
Management of Malignant Melanoma: A Review and an Algorithm Proposal to Eliminate Sentinel Lymph Node Biopsy
Dustin C Derrick, MD
Lawrence Cervino, MD
Summa Health System
Crystal Clinic Plastic Surgery
2018-02-15
Presenter: Dustin C Derrick, MD
Affidavit:
100% of the work done on this project is the work of the resident, and has not been previously published.
Director Name: Douglas Wagner, MD, FACS
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Malignant melanoma rates have been rising for the last 30 years, and approximately 91,270 new melanomas and 9,320 melanoma deaths are expected in 2018 alone. Melanoma overlaps a multitude of specialist's scope of practice and while tumor genetics and therapeutics R&D has exploded in the past decade, references of prognosis and surgical treatment have remained comparatively stagnant. We sought out to review melanoma management strategies, compare outcomes by stage, highlight cases that defy current prognosis logic, and propose the elimination of sentinel lymph node biopsy.
Methods: Retrospective chart review of malignant melanoma cases from 2010-2017 at a single regional melanoma referral center, management strategies, tumor genetics and outcomes data. Primary outcomes were disease free survival, stage-specific mortality, and stage-specific survival advantage in patients treated with biologics and immunomodulators. Other factors investigated were length of follow-up, recurrence rates, discordance rates of prognosis from classical staging vs genetic panels, and survival beyond expected mortality.
Results: We report the statistics from a regional melanoma referral center that sees over 250 melanoma patients a year, report the cases that defy clinical prognostic logic, and propose a future that eliminates sentinel lymph node biopsy from prognostic and surgical decision making algorithms based on comparison with tumor genetic panels and outcomes with newer immunomodulators therapeutics.
Conclusion: After reviewing our historical management of malignant melanoma, we sought to investigate a change in management algorithms that eliminates sentinel lymph node biopsy in favor of relying on tumor genetic workups and aggressive implementation of emerging immunomodulators therapies.
