1
|
Koizumi S, Inozume T, Nakamura Y. Current surgical management for melanoma. J Dermatol 2024; 51:312-323. [PMID: 38149725 DOI: 10.1111/1346-8138.17086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
Melanoma is a major malignant cutaneous neoplasm with a high mortality rate. In recent years, the treatment of melanoma has developed dramatically with the invention of new therapeutic agents, including immune checkpoint inhibitors and molecular-targeted agents. These agents are available as adjuvant therapies for postoperative patients with stage IIB, IIC, and III melanomas. Furthermore, neoadjuvant therapy has been studied in several global clinical trials and has demonstrated promising and favorable clinical efficacy, mainly in patients with palpable regional lymph nodes. A recent large phase III clinical trial investigating early lymph node dissection for sentinel lymph node metastases demonstrated no survival benefits. Based on these data, surgery should be reconsidered as an appropriate treatment modality for melanoma. The need for invasive surgical procedures will be reduced with the invention of effective adjuvant and neoadjuvant therapies and novel clinical trial data on regional lymph node dissection. However, surgery still plays an important role in treating early-stage melanoma, accurately determining the disease stage, and effective palliative treatment for advanced melanoma. In this article, we focus on surgery for primary tumors, regional lymph nodes, and metastatic sites in an era of remarkably revolutionary drug treatments for melanoma.
Collapse
Affiliation(s)
- Shigeru Koizumi
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
- Department of Dermatology, Chiba University, Chiba, Japan
| | | | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| |
Collapse
|
2
|
Krensel M, Petersen J, Stephan B, Katalinic A, Augustin J. Vergleich der Patientenpfade bei der Früherkennungsuntersuchung auf Hautkrebs – eine Sekundärdatenanalyse. J Dtsch Dermatol Ges 2021; 19:389-399. [PMID: 33709581 DOI: 10.1111/ddg.14318_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Magdalene Krensel
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Jana Petersen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Brigitte Stephan
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Lübeck (UKSH), Lübeck
| | - Jobst Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| |
Collapse
|
3
|
Krensel M, Petersen J, Stephan B, Katalinic A, Augustin J. Comparison of patient pathways in the early detection of skin cancer – a claims data analysis. J Dtsch Dermatol Ges 2021; 19:389-398. [DOI: 10.1111/ddg.14318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Magdalene Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Jana Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Brigitte Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology University Medical Center Lübeck (UKSH) Lübeck Germany
| | - Jobst Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| |
Collapse
|
4
|
From Nevi to Melanoma: Understanding the Basics of Lesions. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
5
|
Lamboo LGE, Haydu LE, Scolyer RA, Quinn MJ, Saw RPM, Shannon KF, Spillane AJ, Stretch JR, Bonenkamp JJ, Thompson JF. The optimum excision margin and regional node management for primary cutaneous T3 melanomas (2-4 mm in Thickness): a retrospective study of 1587 patients treated at a single center. Ann Surg 2014; 260:1095-102. [PMID: 25072430 DOI: 10.1097/sla.0000000000000792] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the optimum excision margin and nodal management for patients with primary cutaneous melanomas 2.01- to 4.00-mm thick (T3 melanomas). BACKGROUND Currently available evidence does not reliably define the minimum safe excision margin and best nodal management for patients with primary cutaneous T3 melanomas. METHODS A retrospective study was conducted, analyzing data on 1587 patients with melanomas 2.01- to 4.00-mm thick treated at a single center. RESULTS A histopathologic excision margin of 8 mm or more (equivalent to a ≥1 cm surgical margin) was associated with increased local and in-transit recurrence-free survival [hazard ratio (HR) = 0.54; P = 0.008] and disease-free survival (DFS) (HR = 0.59; P = 0.001) compared with a less than 8-mm margin. The <8-mm group had reduced distant recurrence-free survival (DRFS) compared with the 8- to 16-mm group (HR = 1.63; P = 0.038). On multivariate analysis, patients with a positive sentinel lymph node (SLN) had significantly reduced melanoma-specific survival (MSS), DFS, regional node recurrence-free survival (RNRFS) and DRFS compared with patients with a negative SLN, unless an immediate completion lymph node dissection was performed. Patients in whom an SLN biopsy was not performed had significantly reduced MSS (HR = 2.10; P < 0.001), DFS (P < 0.001), RNRFS (P < 0.001), and DRFS (P = 0.010) compared with patients who received an SLN biopsy. CONCLUSIONS A histopathologic excision margin of 8 mm or more (corresponding to a ≥1 cm surgical excision margin) combined with SLN biopsy (followed by an immediate completion lymph node dissection if positive) provided T3 melanoma patients with optimum local, regional, and distant disease control and resulted in enhanced melanoma-specific survival.
Collapse
Affiliation(s)
- Lieke G E Lamboo
- *Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands †Melanoma Institute Australia, Sydney, New South Wales, Australia Disciplines of ‡Surgery, and §Pathology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; and ¶Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Kimbrough CW, McMasters KM, Davis EG. Principles of surgical treatment of malignant melanoma. Surg Clin North Am 2014; 94:973-88, vii. [PMID: 25245962 DOI: 10.1016/j.suc.2014.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although melanoma represents less than 5% of all skin cancers, it is responsible for the bulk of skin cancer-related deaths. Nevertheless, despite this aggressive reputation, most patients with cutaneous melanoma will be surgically cured of their disease. Early detection allows for curative resection, and 5-year survival for all stages of melanoma is 91%. This review outlines the surgical treatment of melanoma, including principles of wide local excision and management of the regional lymph nodes.
Collapse
Affiliation(s)
- Charles W Kimbrough
- The Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Kelly M McMasters
- The Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Eric G Davis
- The Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40202, USA.
| |
Collapse
|
7
|
De Giorgi V, Saggini A, Grazzini M, Gori A, Rossari S, Scarfì F, Verdelli A, Chimenti S, Lotti T, Massi D. Specific challenges in the management of subungual melanoma. Expert Rev Anticancer Ther 2014; 11:749-61. [DOI: 10.1586/era.10.216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
8
|
|
9
|
Kokolakis A, Zacharakis G, Krasagakis K, Lasithiotakis K, Favicchio R, Spiliopoulos G, Giannikaki E, Ripoll J, Tosca A. Prehistological evaluation of benign and malignant pigmented skin lesions with optical computed tomography. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:066004. [PMID: 22734760 DOI: 10.1117/1.jbo.17.6.066004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Discrimination of benign and malignant melanocytic lesions is a major issue in clinical dermatology. Assessment of the thickness of melanoma is critical for prognosis and treatment selection. We aimed to evaluate a novel optical computed tomography (optical-CT) system as a tool for three-dimensional (3-D) imaging of melanocytic lesions and its ability to discriminate benign from malignant melanocytic lesions while simultaneously determining the thickness of invasive melanoma. Seventeen melanocytic lesions, one hemangioma, and normal skin were assessed immediately after their excision by optical-CT and subsequently underwent histopathological examination. Tomographic reconstructions were performed with a back-propagation algorithm calculating a 3-D map of the total attenuation coefficient (AC). There was a statistically significant difference between melanomas, dysplastic nevi, and non-dysplastic nevi, as indicated by Kruskal-Wallis test. Median AC values were higher for melanomas compared with dysplastic and non-dysplastic nevi. No statistically significant difference was observed when thickness values obtained by optical-CT were compared with histological thickness using a Wilcoxon sighed rank test. Our results suggest that optical-CT can be important for the immediate prehistological evaluation of biopsies, assisting the physician for a rapid assessment of malignancy and of the thickness of a melanocytic lesion.
Collapse
Affiliation(s)
- Athanasios Kokolakis
- University of Crete, University Hospital of Heraklion, Pigmented Lesion and Melanoma Clinic, Department of Dermatology, 71110, Voutes, Heraklion, Crete, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Gareau D, Hennessy R, Wan E, Pellacani G, Jacques SL. Automated detection of malignant features in confocal microscopy on superficial spreading melanoma versus nevi. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:061713. [PMID: 21198161 PMCID: PMC3036174 DOI: 10.1117/1.3524301] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In-vivo reflectance confocal microscopy (RCM) shows promise for the early detection of superficial spreading melanoma (SSM). RCM of SSM shows pagetoid melanocytes (PMs) in the epidermis and disarray at the dermal-epidermal junction (DEJ), which are automatically quantified with a computer algorithm that locates depth of the most superficial pigmented surface [D(SPS)(x,y)] containing PMs in the epidermis and pigmented basal cells near the DEJ. The algorithm uses 200 noninvasive confocal optical sections that image the superficial 200 μm of ten skin sites: five unequivocal SSMs and five nevi. The pattern recognition algorithm automatically identifies PMs in all five SSMs and finds none in the nevi. A large mean gradient ψ (roughness) between laterally adjacent points on D(SPS)(x,y) identifies DEJ disruption in SSM ψ = 11.7 ± 3.7 [-] for n = 5 SSMs versus a small ψ = 5.5 ± 1.0 [-] for n = 5 nevi (significance, p = 0.0035). Quantitative endpoint metrics for malignant characteristics make digital RCM data an attractive diagnostic asset for pathologists, augmenting studies thus far, which have relied largely on visual assessment.
Collapse
Affiliation(s)
- Dan Gareau
- Oregon Health and Science University, Department of Dermatology, Portland, OR, USA.
| | | | | | | | | |
Collapse
|
11
|
Sladden MJ, Balch C, Barzilai DA, Berg D, Freiman A, Handiside T, Hollis S, Lens MB, Thompson JF. Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev 2009:CD004835. [PMID: 19821334 DOI: 10.1002/14651858.cd004835.pub2] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cutaneous melanoma accounts for 75% of skin cancer deaths. Standard treatment is surgical excision with a safety margin some distance from the borders of the primary tumour. The purpose of the safety margin is to remove both the complete primary tumour and any melanoma cells that might have spread into the surrounding skin.Excision margins are important because there could be trade-off between a better cosmetic result but poorer long-term survival if margins become too narrow. The optimal width of excision margins remains unclear. This uncertainty warrants systematic review. OBJECTIVES To assess the effects of different excision margins for primary cutaneous melanoma. SEARCH STRATEGY In August 2009 we searched for relevant randomised trials in the Cochrane Skin Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2009), MEDLINE, EMBASE, LILACS, and other databases including Ongoing Trials Registers. SELECTION CRITERIA We considered all randomised controlled trials (RCTs) of surgical excision of melanoma comparing different width excision margins. DATA COLLECTION AND ANALYSIS We assessed trial quality, and extracted and analysed data on survival and recurrence. We collected adverse effects information from included trials. MAIN RESULTS We identified five trials. There were 1633 participants in the narrow excision margin group and 1664 in the wide excision margin group. Narrow margin definition ranged from 1 to 2 cm; wide margins ranged from 3 to 5 cm. Median follow-up ranged from 5 to 16 years. AUTHORS' CONCLUSIONS This systematic review summarises the evidence regarding width of excision margins for primary cutaneous melanoma. None of the five published trials, nor our meta-analysis, showed a statistically significant difference in overall survival between narrow or wide excision.The summary estimate for overall survival favoured wide excision by a small degree [Hazard Ratio 1.04; 95% confidence interval 0.95 to 1.15; P = 0.40], but the result was not significantly different. This result is compatible with both a 5% relative reduction in overall mortality favouring narrower excision and a 15% relative reduction in overall mortality favouring wider excision. Therefore, a small (but potentially important) difference in overall survival between wide and narrow excision margins cannot be confidently ruled out.The summary estimate for recurrence free survival favoured wide excision [Hazard Ratio 1.13; P = 0.06; 95% confidence interval 0.99 to 1.28] but again the result did not reach statistical significance (P < 0.05 level).Current randomised trial evidence is insufficient to address optimal excision margins for primary cutaneous melanoma.
Collapse
Affiliation(s)
- Michael J Sladden
- Department of Medicine, University of Tasmania, Launceston General Hospital, Launceston, Tasmania, Australia, 7250
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Bakhai M, Hopster D, Wakeel R. A retrospective study comparing the accuracy of prehistology diagnosis and surgical excision of malignant melanomas by general practitioners and hospital specialists. Clin Exp Dermatol 2009; 35:63-7. [PMID: 19778304 DOI: 10.1111/j.1365-2230.2009.03507.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A retrospective study was carried out to compare the overall standard of surgical excision of malignant melanomas (MMs) between general practitioners (GPs) and hospital specialists before and after the introduction of the UK melanoma guidelines between 1989 and 2006. In total, 213 melanoma excision reports were examined and surgical excision margins recorded. The results showed a significant difference in the rate of adequate surgical excision margins (at all levels of Breslow thickness) between GPs and hospital specialists, with hospital specialists excising melanomas with safe surgical excision margins at a significantly higher rate compared with GPs. Since the introduction of the guidelines in 2002, GPs showed a significant improvement in the completeness of melanoma excision but remained poor at prehistology diagnosis and in particular at taking adequate excision margins. Implementation of the guidelines has not produced significant improvements in adequacy of excision margins in both primary and secondary care. The results show that hospital specialists maintained a high standard of prehistological diagnosis and completeness of excision throughout the time of the study, performing at a significantly higher standard compared with GPs. Our conclusions concur with the UK melanoma guidelines and the National Institute for Health and Clinical Excellence guidelines, which suggest that lesions suspicious for melanoma should be urgently referred to a dermatologist or plastic surgeon for surgical excision and should not be surgically excised in primary care, particularly if lesions have a Breslow thickness > 2 mm. We suggest that the new guidelines need to be more aggressively implemented in primary care and guidance introduced to improve the accuracy of diagnosis, with better training provided for GPs.
Collapse
Affiliation(s)
- M Bakhai
- Department of Derrmatology, Whittington Hospital, London, UK
| | | | | |
Collapse
|
13
|
Callejo Peixoto I, Meneses e Sousa J. Clinical and biological aspects of sentinel node biopsy in malignant melanoma — an update. Clin Transl Oncol 2005; 7:145-9. [PMID: 15960920 DOI: 10.1007/bf02708751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The diagnostic usefulness of sentinel lymph node biopsy (SLNB) has been well established, but its therapeutic value remains unproven. First introduced by Morton and colleagues, the SLNB procedure is now widely available, and markedly enhances our ability to pathologically stage the regional nodes. Although the SLN status is acknowledged as the most powerful indicator of prognosis in melanoma, there is no evidence to-date, of survival advantage for complete lymphadenectomy in SLN-positive patients. Also, there is no effective adjuvant therapy that could benefit these sentinel node-positive patients, as yet. Additionally, new data have emerged indicating a possible increase in local/in-transit recurrence following complete lymphadenectomy in sentinel node-positive patients. To understand fully and to evaluate these observations we need information from randomized controlled trials. Major changes have occurred following the latest revision of melanoma staging system (AJCC, 6th edition). Concerning N category, these include the incorporation of the number of metastatic lymph nodes, the tumour burden of nodal metastases, and the ulceration of the primary tumour. The data obtained from the new staging system will reflect differences in prognosis that were not previously emphasized and which, we hope, will serve as a guide to more accurate analysis of metastatic pathways in cutaneous melanoma as well as a rationale for new forms of treatment.
Collapse
|
14
|
Abstract
This article reviews the clinical characteristics, histology, biologic behavior, and recommended treatment for several benign and malignant lesions that may arise on the head and neck. Nevus sebaceus and congenital melanocytic nevus are two benign lesions that can present at a size of several centimeters. Surgical excision may be considered for cosmetic purposes and to reduce the small risk for the development of malignancy within each lesion. Basal and squamous cell carcinoma, lentigo maligna and lentigo maligna melanoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma are malignant lesions for which surgical excision is the recommended treatment. Local flap reconstruction may be used to address the surgical defects resulting from excision of these benign and malignant conditions.
Collapse
Affiliation(s)
- Julia K Padgett
- Department of Dermatology, University of Virginia, Primary Care Center, Third Floor, Lee Street, Charlottesville, VA 22908, USA.
| |
Collapse
|
15
|
McKenna DB, Marioni JC, Lee RJ, Prescott RJ, Doherty VR. A comparison of dermatologists', surgeons' and general practitioners' surgical management of cutaneous melanoma. Br J Dermatol 2004; 151:636-44. [PMID: 15377351 DOI: 10.1111/j.1365-2133.2004.06065.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current guidelines for the surgical management of melanoma aim to bring a combined consensus approach to the surgery of melanoma. Whether different outcomes for melanoma are related to the specialist who treats the patient is unknown. OBJECTIVES To examine the clinicopathological features and surgical management of patients with primary cutaneous malignant melanoma treated by dermatologists, general surgeons, plastic surgeons and general practitioners (GPs). We also examined if the category of specialist had an effect on the survival outcome for the patient. METHODS A retrospective, observational study of patients registered on a specialist database that records the clinicopathological features, surgical treatment and follow-up information of patients with malignant melanoma in Scotland. The patients had invasive primary cutaneous malignant melanoma without evidence of metastasis at the time of surgery, diagnosed between 1979 and 1997, with follow-up to the end of December 1999. Clinicopathological characteristics and surgical treatment of patients were compared for the four groups of specialist, as were overall survival (OS), disease-free survival (DFS) and recurrence-free interval (RF). RESULTS Of 1536 patients, 663 (43%) were treated initially by a dermatologist, 486 (32%) by a general surgeon, 257 (17%) by a plastic surgeon and 130 (8%) by a GP. The proportion of patients managed by dermatologists rose over the lifetime of the study. Compared with the other specialists, the patients treated by general and plastic surgeons were older; a higher proportion of female patients was managed by dermatologists; median tumour thickness, lesion diameter and frequency of ulceration were all greater in the general surgeon-treated group; plastic surgeons treated a higher proportion of lentigo maligna melanomas; and general surgeons and GPs saw a higher proportion of nodular melanomas. Over 90% of patients managed by a dermatologist or GP underwent wider local excision following initial excision, compared with 43% and 25%, respectively, in the general and plastic surgery groups. General surgeons used wider excision margins than the other specialists. OS, DFS and RF were significantly better in the dermatology group compared with the general and plastic surgery groups. CONCLUSIONS This study showed that dermatologists manage an increasing majority of melanoma patients and that there were significant differences in the surgical treatment of melanoma between dermatologists and surgeons. Survival was significantly better in the dermatology-treated group, suggesting that dermatologists should have a central role in melanoma management.
Collapse
Affiliation(s)
- D B McKenna
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh EH3 9WY, UK.
| | | | | | | | | |
Collapse
|
16
|
Casanova Seuma JM, Ribera Pibernat M. [Melanoma]. Aten Primaria 2004; 33:335-46. [PMID: 15087080 PMCID: PMC7676023 DOI: 10.1016/s0212-6567(04)70803-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- J M Casanova Seuma
- Servei de Dermatologia, Hospital Universitari Arnau de Vilanova, Facultat de Medicina, Universitat de Lleida, Lleida, España.
| | | |
Collapse
|
17
|
Eedy DJ, English JSC. Updates from the British Association of Dermatologists 83rd Annual Meeting, 1-4 July 2003, Brighton, U.K. Br J Dermatol 2004; 150:11-32. [PMID: 14746613 DOI: 10.1111/j.1365-2133.2004.05774.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- D J Eedy
- Craigavon Area Hospital Group Trust, 68 Lurgan Road, Portadown BT63 5QQ, U.K.
| | | |
Collapse
|
18
|
Affiliation(s)
- D J Eedy
- Department of Dermatology, Craigavon Area Hospital Group Trust, 68 Lurgan Road, Portadown BT63 5QQ, U.K.
| |
Collapse
|