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Melanoma is the most aggressive form of skin cancer,, a fact that demonstrates the importance of early diagnosis and treatment. Although modern therapeutic approaches include immunotherapy and targeted therapy, surgery remains to this day the main and most effective method for the primary treatment of melanoma. 

What is melanoma and what should we know about it?

Melanoma is a type of skin cancer that arises from melanocytes, the cells that produce melanin, the substance that gives skin its color. Melanoma can occur anywhere on the body, but is most often seen in areas exposed to the sun, such as the back and face in men, or the extremities in women. Rarely, it can also appear on mucous membranes or even in the eyes. 

Despite the fact that melanoma is less common than other types of skin cancer, its spread has increased rapidly in recent years, especially in countries with high sunshine and a white population. The development of melanoma is associated with excessive exposure to natural and artificial ultraviolet radiation (UV), fair skin and the presence of burns in childhood. Other risk factors are certain skin conditions such as moles (olives) or abnormal skin spots, heredity and genetic predisposition, as well as immunosuppression.  

What are the symptoms and diagnostic criteria? 

Melanoma can appear as a new spot (de novo or an existing mole that changes in color, size, or appearance. Some of the common symptoms include: changes in shape or size, irregular circumference, changes in color, bleeding or ulceration, itching, or pain. A typical method of examining moles is the ABCDE method, which includes the following features:  

• A(Asymmetry)– Asymmetric shape.

• B(Border)– Irregularthe border.

• C(Color) – Multiple colors or uneven color distribution.

• D(Diameter) – Diameter greater than 6 millimeters. 

• E(Evolving) – Change in size, shape or color over time. 

What is the role of surgery in the treatment of melanoma?

Surgery is the treatment of choice for early stages of melanoma. After clinical examination and dermatoscopy, biopsy and confirmation of the diagnosis, the main goal of treatment is wide local excision (complete removal of the primary tumor with free surgical margins), in order to minimize the risk of recurrence. The extent and depth of the resection is determined mainly by the thickness of the tumor, as well as by other histological factors such as the presence of ulceration or the rate of mitoses. 

What is the significance of the sentinel lymph node and lymphadenectomy?

Sentinel lymph node biopsy is a minimally invasive procedure. invasive technique that is an important tool for staging and determining the patient’s prognosis. The sentinel lymph node is the first lymph node to which melanoma is likely to have spread through the lymphatic circulation. This biopsy is performed by a specialized surgical oncologist by injecting a radioactive substance and dye around the tumor, in order to locate and remove the lymph node. If cancer cells are found in it, then the patient is considered to suffer from lymph node disease, which directly affects the therapeutic strategy. Lymph node clearance of the area (radical lymphadenectomy) is now applied in selected cases, taking into account the number, size and characteristics of the infiltrated lymph nodes, the general condition of the patient and the possibility of recurrence.  

Is Surgery Relevant in Advanced Stages of the Disease?

Although immunotherapy and targeted therapies dominate in advanced forms of melanoma, surgery still plays an important role, especially when it comes to oligometastatic disease, e.g. removal of isolated metastases (lung, liver, adrenal gland) and recurrences or in the context of palliative therapy.  

What is the modern approach to the treatment of melanoma?

The modern approach to the treatment of melanoma is multifactorial. Surgical treatment is often combined and enhanced with immunotherapy, targeted therapy and/or radiotherapy. Combined and personalized treatment, based on tumor and patient characteristics, has significantly increased the survival expectancy of patients with melanoma, even in advanced stages. 

Conclusion 

Surgical treatment of melanoma remains a cornerstone in the therapeutic strategy of melanoma, especially in the early stages of the disease, offering many patients the possibility of complete cure. Modern surgical techniques, the use of sentinel lymph node biopsy and the interdisciplinary and personalized approach have upgraded the role of Surgery not only as a therapeutic, but also as a diagnostic tool, while they are a prerequisite for providing optimal care to patients with melanoma.