A novel surgical margin (1 cm) might be from benefit for patients with dysplastic nevi, thin melanomas, and melanoma in situ: Analysis based on clinical cases

Personalised Оne Step Melanoma Surgery and the Outdated/Current Guidelines for Surgical Treatment of Cutaneous Melanoma: Facts and Controversies

One step melanoma surgery (OSMS) is an innovative, personalized approach to the surgical treatment of cutaneous melanoma, which not only follows the total resection fields recommended by AJCC and EJC, but also has a significant advantage over these guidelines; namely, conduction of the procedure within a single surgical session. Guidelines for personalized surgical treatment of cutaneous melanoma can be used at any stage of the disease. The ideal purposes/goals of these newly introduced guidelines are to reduce the number of locoregional and distant recurrences and to stop the advancement of melanomas in a subsequent stage. In contrast to the histology, which under AJCC/EJC guidelines determines the extent of the subsequent or second surgical intervention, the leading starting points for personalized one step melanoma surgery are completely different and based on a complex final assessment, including: 1) clinical and dermatoscopic characteristics in favor of cutaneous melanoma, 2) preoperative ultrasound determination of tumor thickness, and, if possible, 3) the conduction of confocal microscopy. Another important and innovative proposal of the newly created OSMS guidelines is the requirement of absolute reciprocity between the preoperatively measured and subsequent histopathologically established surgical margins. The lack of such reciprocity under previously established guidelines (AJCC/EJC) till the present moment seriously calls into question the reliability of the data shared in the medical field concerning the size of resection fields. Three patients with suspected melanocytic lesions are presented and the applicability, advantages, and disadvantages of the personalized one step melanoma surgery versus two step melanoma surgery (AJCC/EJC) are discussed.

The Future of Personalized Medicine: One Step Melanoma Surgery

The divergent, personalized approach in the surgical treatment of cutaneous melanoma is the one in which the treatment of the neoplasm differs from that proposed within the generally accepted standards or guidelines. According to their presumption, guidelines are not obligatory for the treatment of a certain type of disease and cannot replace the judgment of the clinician. Which to a large extent determines the freedom (or possible one) of the clinician‘s action regarding the „personalization“ in the choice of a new, divergent therapy. It is interesting, for example, that the occurrence of locoregional recurrences in patients with melanoma after guideline therapy insures clinicians against both criticism of treatment choice and the end results. However, the lack of recurrences after innovative/personalized surgical treatment of cutaneous melanoma is accompanied for unknown reasons by a serious dose of unwarranted criticism. The fact is that a personalized surgical approach in the treatment of skin melanomas and the recommended by AJCC guidelines approach lead to exactly the same end results and that should not be ignored. The difference lies in the fact that this end result can be achieved by one step melanoma surgery (OSMS), for example, which is carried out in a single surgical session. Several advantages of OSMS can be noted: 1) it provides high efficiency in a short time, even in the initial stage of the disease, 2) it is cost-effective, and 3) according to initial clinical observations we have a much lower to no propensity for locoregional relapses.