Dr. Shapiro on Surgical Advancements in Field of Melanoma

Richard L. Shapiro, MD, associate professor, Department of Surgery, New York University Langone Medical Center, discusses recent advancements related to surgery in the field of melanoma.

Regardless of systemic, therapeutic advancements, melanoma is predominantly a surgical disease, and 95% of patients are able to be cured with surgery alone, Shapiro explains. Practitioners usually think about the treatment of melanoma surgically in 3 different categories. One is the treatment of the primary melanoma, the second is the treatment of the lymph nodes, and the third is the treatment of metastatic melanoma to other sites, he adds.

Melanoma is different than other skin cancers and mostly different from other tumors in that it has the ability to spread very aggressively locally and to form satellite metastases around it. One hundred years ago, Shapiro says, surgeons took 10- to 15-centimeter margins around melanomas because they thought that melanoma spreads very broadly along the underlying [fascial] planes. However, studies show that this is not how melanoma spreads. There have been many prospective randomized studies conducted to determine how narrow surgeons can get when removing a melanoma so that the surgery is not disfiguring to the patient.