malignant melanoma

1. SURGICAL TREATMENT METHODS AND EVOLUTION OF PATIENTS
WITH MELANOMA FROM THE BUCHAREST ONCOLOGY INSTITUTE
,BUCHAREST, ROMANIA BETWEEN 01/01/2014 AND 05/05/2018
Authors : Sinziana Ionescu,* Eugen Bratucu*,
*First Clinic of General surgery and surgical oncology from the Bucharest Oncology Institute,
“Carol Davila” University of Medicine and Pharmacy , Bucharest, Romania
Background: The authors considered of
particular interest to study the methods of
surgical treatments applied in the case of
patients with melanomas, In a hospital centre
with multiple therapies available, we wished to
study the impact of different surgical
interventions on the outcome: surgery both of
the primary tumour and of the relapses and
secondary determinations.
Material and methods: We performed a
retrospective study from 01/01/2014 to
05/05/2018 in which we extracted from a total
of 2641 procedures performed at a cutaneous
level ,those that were done in the case of
melanomas and we found 1324 were
performed in the case of patients with
melanomas .Out of those, 123 patients were
diagnosed and treated for melanomas in
different stages of evolution , not only at the
cutaneous level. . All of them had surgery
during their treatment evolution, either
surgical procedures of the primary tumour
,either surgical excision of the sentinel lymph
node/nodes or regional lymphadenectomy or
excision of the secondary tumour sites.
Results: Better outcomes were encountered in
the cases of the patients with regional
lymphadenectomies (25% of the total), and the
possibility to perform complete surgical
excisions of the tumour sites or of the entire
group of lymph nodes . 1 of the 5 lymph nodes
excised in the case of melanomas, were
affected by the disease . The techniques for
excision were either through the scintigraphy
technique, either through lymphadenectomy.
When tumour tissues were left in place due to
the impossibility to technically perform
complete excisions, the consequent responses
to adjuvant treatments, such as chemotherapy,
were lower than in cases when the excision
could be done .
Conclusions: Surgical treatment of the
melanomas performed in different stages of
the disease improves outcome and further
response to other treatment methods, which,
in their turn, decrease the probability for the
relapse to appear.
0 5 10 15 20 25 30 35 40
suspicion of ln involvement
confirmed ln involv
inguinal ln involv
invasion in two ln regions
invasion in 3 ln regions
suspicion of ln
involvement
confirmed ln involv inguinal ln involv
invasion in two ln
regions
invasion in 3 ln
regions
Series1 40 30 15 14 24
Different levels of the lymph node
involvement encountered in the study
cutaneous re
excision
8%
cutaneous re
excision and
sentinel lymph
node
16%
cutaneous excision
and sentinel lymph
node
25%
regional uni or
bilateral
lymphadenectomy
22%
other procedures
(finger amputation
, RFA of the non
resectable lymph
nodes )
29%
Surgical procedures in the study group
0
10
20
30
40
50
60
70
thorax
superior limb
inferior limb
other locations
(for instance head
and neck
,abdominal,
lumbar,face,
genitals)
70
25
20
8
Tumor location of the melanomas
Nodular haemorrhagic melanoma resected with its
safe margins