The Division of Surgical Oncology has a long-standing history in the treatment of melanoma. This includes state of the art care for the melanoma patient, as well as the development of innovative treatment approaches. The basic research focus has been on the development of immunotherapy for melanoma. The goal of surgery for melanoma is to completely remove all of the disease. Until 15 years ago, this was thought to require a 3-5 cm. margin of normal tissue around the primary tumor. This led to ablative surgeries with poor cosmetic results. Based on well designed research it is now known that melanomas less than 1 mm thick are adequately excised with a 1 cm margin and melanomas between 1 mm and 4 mm are adequately excised with a 2 cm margin. This allows for an improved cosmetic result after excision with the same overall outcome. The division has the advantage of having Dr. Howard Edington, a board-certified plastic surgeon, for necessary flap reconstructions after excision for an improved cosmetic result.

Elective regional lymph node dissection in the absence of obvious nodal metastases is a controversial procedure. Prospective randomized trials in clinical stage I melanoma find no overall survival advantage for elective lymph node dissection. Sentinel lymph node mapping allows for a directed approach at lymph node biopsy to detect microscopic tumor within the lymph node most likely to obtain metastases if they exist. This helps avoid unnecessary ablative surgery which can lead to limb swelling and pain. We often use the results of the sentinel lymph node biopsy to direct systemic therapy. We work very closely with our medical oncology colleagues to appropriately recommend chemotherapy or biologic therapy given through the whole body when indicated.

Isolated Limb perfusion is performed by Dr. John Kane and Dr. David Bartlett for the treatment of melanoma that has spread within an arm or leg. This type of spread can be treated by delivering concentrated chemotherapy directly to the involved limb while preventing exposure of the rest of the body to the drugs.

Our overall focus is to maintain the best possible outcome for patients with melanoma, while minimizing the patient cost in terms of poor cosmetic outcome, pain, and extremity swelling. In addition, we make sure that the most appropriate adjuvant therapies and investigational biologic therapies are offered to patients based on the most current data.