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Cutting too much or too little around the melanoma tumor causes problems, new guidelines should help surgeons get it just right Contact Now

New melanoma surgery guidelines may help reduce medical malpractice

Cutting too much or too little around the melanoma tumor causes problems, new guidelines should help surgeons get it just right

Melanoma is an aggressive form of skin cancer that grows in width and depth. As a whole, skin cancer is the most common type of cancer, and melanoma makes up about 1% of skin cancer diagnoses.

Cancer experts believe that exposure to the sun’s ultraviolet rays leads to most cases of skin cancer. Any blistering sunburn increases a person’s risk of developing skin cancer or melanoma. The best treatment is prevention. That’s why doctors, nurse practitioners (NPs), and physician’s assistants (PAs) encourage using a skin protection lotion, wearing sunglasses, and even wearing a hat when spending time in the sun.

Their recommendations pay off. In countries where the guidelines are followed from childhood up, the rates of skin cancer and melanoma have decreased.

According to the Melanoma Research Alliance, there’s still room to improve in the United States. The Centers for Disease Control and Prevention (CDC) report that the number of melanoma cases has doubled during the past 30 years. Experts expect over 100,000 people to be diagnosed with new cases of melanoma. The average age of patients at melanoma diagnosis is 63, but it can affect people of all ages. In fact, it’s one of the most common cancers in young adults.

When melanoma is diagnosed and treated early, the survival odds are excellent. The five-year survival rate, which is the statistic that’s most often used when referring to cancer survivability, for early melanoma is 98%. The five-year survival rate plummets to 25% if the melanoma spreads to distant sites.

The success of early treatment is why dermatologists recommend having an annual appointment for a skin check. This allows the skin doctor to make a record of your baseline skin condition, which is updated each year, and allows easier identification for new areas of concern.

Melanoma surgery

When a patient is diagnosed with melanoma, the treatment generally starts with surgery, and may be followed with chemotherapy or radiation therapy. Several types of physician specialists routinely perform melanoma surgery, including dermatologists, surgical oncologists, and plastic surgeons.

The first goal of melanoma surgery is to resect all of the primary tumor. The surgeon sends the tumor mass to a pathology lab, where a pathologist physician reviews it under a microscope. Here’s the terminology that pathologists use to describe the degree of the surgeon’s success in resecting the primary tumor:

• R0 resection: No cancer cells seen microscopically at the margins of the primary tumor site. This is the best report.

R1 resection: Cancer cells seen microscopically at the margins of the primary tumor site.

R2 resection: Cancer cells seen macroscopically at the margins of the primary tumor site.

It’s important to remove a proper margin around the tumor

The second goal of melanoma surgery is to resect a margin of healthy tissue around the primary tumor. The idea behind this standard of care is that it’s usually straightforward for the surgery to resect or remove that part of the melanoma that can be seen and felt, but there’s the potential for some microscopic melanoma cells to remain in the area surrounding the main tumor.

When pathologists examine the tissue margins under a microscope, they use this terminology to describe their findings:

Negative margin : No cancer cells or tumor at the margin. This is the best report.

Microscopic positive margin: Cancer cells or tumor can be seen microscopically at the margins of the primary tumor site.

Macroscopic positive margin: The pathologist can see cancer cells or tumor by the naked eye at the margins of the primary tumor site.

Margin not assessed: The pathologist didn’t assess the margins of the primary tumor site, either because of an inadequate tissue sample or some other reason.

New recommendations for melanoma surgery margins

In my experience, one of the most common forms of medical malpractice related to melanoma surgery occurs when the surgeon fails to resect adequate margins. This leaves microscopic melanoma cancer cells in the patient’s body, giving them an opportunity to grow, spread (metastasize), and seed other parts of the body.

Inadequate margins may also lower the success rate of chemotherapy and radiation therapy and may decrease the patient’s overall survival rate.

On the other end of things, some surgeons resect far more healthy tissue than necessary, leaving patients with unsightly scarring and even missing holes of flesh that can limit function and cause impairments.

Recent research found that tumors located in the trunk area of the body were more likely to be resected with larger than necessary margins. Tumors in the head, neck, and more visible areas of the body were less likely to be removed with excessively large margins.

Following new medical research and a peer-reviewed study, the National Comprehensive Cancer Network has issued guidelines regarding appropriate margins for resection during melanoma surgery:

https://advancingthescience.mayo.edu/2020/05/12/melanoma-surgery-when-more-isnt-necessarily-better/

For small tumors with a thickness of 1 mm or less: 1 cm margin

For intermediate tumors: 1–2 cm margin

For larger tumors with a thickness of greater than 2 mm: 2 cm margin

The key in melanoma surgery is for the surgeon to remove the whole primary tumor and then follow the Goldilocks principle—resect margins that are just right.

If you’ve been seriously injured because of poor or substandard melanoma care, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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