Primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in cutaneous melanoma: a clinical practice guideline
| Autor: | David R. McCready, Christian Murray, N.J. Look Hong, Frances C. Wright, Scott Johnson, D Ghazarian, D P Goldstein, L H Souter, Carolyn Nessim, J Toye, S Kellett, Alexandra M. Easson, Teresa M. Petrella |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Skin Neoplasms medicine.medical_treatment Sentinel lymph node margins Disease-Free Survival 03 medical and health sciences wide excision margins melanoma in situ 0302 clinical medicine sentinel lymph nodes Medicine Humans 030212 general & internal medicine Lymph node Melanoma Randomized Controlled Trials as Topic Ontario practice guidelines Evidence-Based Medicine business.industry Sentinel Lymph Node Biopsy Wide local excision Margins of Excision completion lymph node dissection Guideline Sentinel node medicine.disease Dissection medicine.anatomical_structure Treatment Outcome Practice Guideline 030220 oncology & carcinogenesis Lymphatic Metastasis Cutaneous melanoma Practice Guidelines as Topic Lymph Node Excision Radiology sentinel lymph node metastases business Systematic Reviews as Topic |
| Zdroj: | Current Oncology Volume 26 Issue 4 Pages 4885-550 |
| Popis: | Background: For patients who are diagnosed with early-stage cutaneous melanoma, the principal therapy is wide surgical excision of the primary tumour and assessment of lymph nodes. The purpose of the present guideline was to update the 2010 Cancer Care Ontario guideline on wide local excision margins and sentinel lymph node biopsy (slnb), including treatment of the positive sentinel node, for melanomas of the trunk, extremities, and head and neck. Methods: Using Ovid, the medline and embase electronic databases were systematically searched for systematic reviews and primary literature evaluating narrow compared with wide excision margins and the use of slnb for melanoma of the truck and extremities and of the head and neck. Search timelines ran from 2010 through week 25 of 2017. Results: Four systematic reviews were chosen for inclusion in the evidence base. Where systematic reviews were available, the search of the primary literature was conducted starting from the end date of the search in the reviews. Where systematic reviews were absent, the search for primary literature ran from 2010 forward. Of 1213 primary studies identified, 8 met the inclusion criteria. Two randomized controlled trials were used to inform the recommendation on completion lymph node dissection. Key updated recommendations include: (1) Wide local excision margins should be 2 cm for melanomas of the trunk, extremities, and head and neck that exceed 2 mm in depth. (2) SLNB should be offered to patients with melanomas of the trunk, extremities, and head and neck that exceed 0.8 mm in depth. (3) Patients with sentinel node metastasis should be considered for nodal observation with ultrasonography rather than for completion lymph node dissection. Conclusions: Recommendations for primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in patients with cutaneous melanoma have been updated based on the current literature. |
| Databáze: | OpenAIRE |
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