(OSMS)- One Step Melanoma Surgery for Nevoid melanoma?

Abstract

We describe a 48-year-old patient with a present cutaneous pigment lesion located in the left scapular area. About 15 years duration of the finding, as the lesion being suspected clinically and dermatoscopically for cutaneous melanoma. The patient was initially treated with a surgical margin of 0.5 cm in all directions, with a tumor thickness of 3 mm immediately established afterwards. The subsequent surgical session 9 days later (as recommended by the AJCC) included: 1) removal of 4 sentinel lymph nodes: 3 of them located infrascapularly and one axillary apically to the left and 2) reexcision of the primary surgical wound with a safety margin of 1.5 cm in all directions. Lymph node involvement data are lacking and the patient is staged as IIA (T3a N0M0). Using a worldwide medical database as PubMed/Medline, it could be at least suggested that the determination of the tumor thickness in clinically and dermatoscopically indicative for melanoma cutaneous lesions (especially when they are over 2 or 3 mm) should not be a serious challenge. In pigmented lesions with clear clinical and dermatoscopic data in the direction of cutaneous melanoma, the role of high-frequency pre-operative ultrasound could be essential for reducing the number of surgical sessions from two to one. The case presented is indicative of how lesions with similar clinical and dermatoscopic morphology could be treated and how guidelines can be individually optimized on the basis of the individual clinical experience. In fact, it turns out that one-step melanoma surgery (OSMS) could be a good therapeutic option in a specific type of patient.