Personalised Оne Step Melanoma Surgery and the Outdated/Current Guidelines for Surgical Treatment of Cutaneous Melanoma: Facts and Controversies

Abstract

Abstract 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.