Although the vast majority of patients heal well there are occasional complications that can occur - both short term and long term. Short term complications can include infection, minor bleeding, and would dehiscence (opening). These are treatable with wound care and antibiotics (and tincture of time). Longer term complications can include excessive scarring (keloid formation) and nerve sensitivity (pain, burning, numbness).

After the wide excision and sentinel lymph node biopsy, the pathology report will typically take 2-4 days to get back. If the sentinel lymph node has melanoma that has spread to the lymph node, the standard treatment will be a completion lymph node dissection of whatever lymph node basin that lymph node was removed from. That operation is usually performed ~1-2 weeks after the initial wide excision/sentinel node biopsy. There is a major international prospective randomized study - the Multicenter Selective Lymphadenectomy Trial 2 (MSLT-2) that is evaluating whether it is necessary to remove the rest of the lymph nodes from the basin after a positive sentinel lymph node biopsy. For more information on the trial you can search the internet or email me at beitsch@aol.com.

Most patients with melanoma will undergo a wide excision of their primary melanoma and a sentinel lymph node biopsy (the 1-3 lymph nodes that drain the patch of skin where the melanoma was). The operative time varies by 1) how big the wide excision needs to be (typically 1cm in radial diameter excision per millimeter in thickness of the melanoma up to 3cm) 2) method of reconstruction (filling the defect) with advancement or rotation flaps or skin grafts and 3) how many lymph node basins (draining areas - axillary, groin, neck) and how many lymph nodes need to be removed. All that said, my surgeries usually take 30 min to 1 hour for most patients.

Recovery after a wide excision varies by the amount of the excision, the method of reconstruction (filling the hole), and the location of the incisions. In general, the procedure is an out patient surgery so you get to sleep in your own bed. Occasionally patients are admitted but usually for other issues such as their other medical conditions or extent of other surgery done at the same time (like a lymphatic dissection). Obviously, the bigger the excision necessary, the longer the incisions are and more healing will be required. The healing of the wide excision varies by same parameters plus the patient's other health issues - generally the farther down the body the harder it is to heal (feet harder than trunk for example). Patients with poor circulation due to vascular disease (narrowed blood vessels), heal less well; diabetics generally heal less well; and some medical conditions like auto immune diseases (rheumatoid arthritis, lupus, etc) are often on medicines that slow healing.

The American Joint Commission on Cancer or AJCC has a staging system for all cancers including melanoma. Using melanoma thickness, the presence or absence of lymph node metatstasis and presence or absence of systemic (body) spread, the staging system will place you in a Stage that corresponds to a percentage of patients who survival for a specified time period (typically 5 years). This staging system is updated every few years to insure it has the latest data on melanoma. This is only for patients who have had a melanoma. As far as calculating your risk of getting a melanoma, there is no model where you plug in parameters and then get your chance of getting melanoma.

Accelerated Partial Breast Irradiation (APBI) has been around for almost 20 years but has gained in popularity over the past 10 years with the introduction of the Mammosite brachytherapy balloon catheter (which allowed easier treatment). The technique has been refined and modified over the last 10 years and now includes devices iwth multiple lumens (instead of the single catheter Mammosite), computerized 3-D CT treatment planning (originally treatment plans were done off plane X-Rays), and even APBI delivered by external beams not requiring any device placement within the breast. The future is bright for this 'targeted' treatment with shorter courses of treatment, intra-operative one dose treatments, and even 'CyberKnife' steroradiosurgical approaches (smaller beams of radiation from many different angles).

After the office consultation, I always have a surgical plan laid out for that patient. This usually includes widely excising the primary (skin) melanoma and often removal of the regional (draining) sentinel lymph nodes. The wide excision wound must be closed with either a skin graft or a flap (undermining of the skin surrounding the open wound in order to get the skin loose enough to stitch it back together). I then discuss this plan with my nurse who schedules the procedure and she will then go over the specifics/timings of the the pre-op tests (lymphoscintigraphy to map the skin and find the sentinel node) and the actual surgery day. The day of (or evening before) I review the chart and my plan of action.

The surgical oncologist will usually give the patient an estimate of the risk of the skin melanoma spreading to the sentinel (draining) lymph node. This risk varies by the thickness of the melanoma (the thicker melanoma, the greater chance of spread) and the presence of ulceration (ulcerated melanomas have greater chance of spread). Remember, the vast majority of melanomas have NOT spread to the sentinel nodes regardless of their thickness/ulceration. However, waiting for the pathology to return is always the hardest part of melanoma surgery (mentally). It usually takes 2-4 working days for the report to be finished so I tell everyone to try not to stress during this time (easy for me to say, hard for them to do).

Melanomas (and most cancers) are staged by 3 means - tumor, nodes, and distant metastases. For melanoma the 'tumor' is actually a measurement of the exact thickness of the melanoma measured in millimters. 'Thin' melanomas are less than 0.75 millimeter thick. The risk of spreading elsewhere (either to regional lymph nodes or throughout the body) is extremely low in 'thin' melanomas. Often, the removal of the sentinel lymph node (the lymph node that drains that patch of skin) is not done for thin melanomas but this will be a decision for you and your surgical oncologist.

Great question and really the 'Holy Grail' we are seeking. Foreign cells are foreign cells regardless if they are melanoma cells or kidney cells (from a transplant). The reason why the patient doesn't recognize their own melanoma cells as harmful and kill them is complex. First of all, the patient probably does recognize many different cancers as foreign and throughout their life, destroys them before they reach a point they are apparent to the patient or their doctor (this is a raging question in breast cancer right now - do screening mammograms pick up cancers that never become clinically apparent but which get lots of 'unnecessary' treatment). For unknown reasons (depressed host immunity, host immunity actually suppressing the host's ability to kill the melanoma [actually the basis of Yervoy - which lessened host suppression by removing T Suppressor cells], or the melanoma cells becoming 'smarter' at concealing themselves), the patient's melanoma will not be recognized as foreign and therefores grows unregulated.

Although the vast majority of patients heal well there are occasional complications that can occur - both short term and long term. Short term complications can include infection, minor bleeding, and would dehiscence (opening). These are treatable with wound care and antibiotics (and tincture of time). Longer term complications can include excessive scarring (keloid formation) and nerve sensitivity (pain, burning, numbness).

After the wide excision and sentinel lymph node biopsy, the pathology report will typically take 2-4 days to get back. If the sentinel lymph node has melanoma that has spread to the lymph node, the standard treatment will be a completion lymph node dissection of whatever lymph node basin that lymph node was removed from. That operation is usually performed ~1-2 weeks after the initial wide excision/sentinel node biopsy. There is a major international prospective randomized study - the Multicenter Selective Lymphadenectomy Trial 2 (MSLT-2) that is evaluating whether it is necessary to remove the rest of the lymph nodes from the basin after a positive sentinel lymph node biopsy. For more information on the trial you can search the internet or email me at beitsch@aol.com.

Most patients with melanoma will undergo a wide excision of their primary melanoma and a sentinel lymph node biopsy (the 1-3 lymph nodes that drain the patch of skin where the melanoma was). The operative time varies by 1) how big the wide excision needs to be (typically 1cm in radial diameter excision per millimeter in thickness of the melanoma up to 3cm) 2) method of reconstruction (filling the defect) with advancement or rotation flaps or skin grafts and 3) how many lymph node basins (draining areas - axillary, groin, neck) and how many lymph nodes need to be removed. All that said, my surgeries usually take 30 min to 1 hour for most patients.

Recovery after a wide excision varies by the amount of the excision, the method of reconstruction (filling the hole), and the location of the incisions. In general, the procedure is an out patient surgery so you get to sleep in your own bed. Occasionally patients are admitted but usually for other issues such as their other medical conditions or extent of other surgery done at the same time (like a lymphatic dissection). Obviously, the bigger the excision necessary, the longer the incisions are and more healing will be required. The healing of the wide excision varies by same parameters plus the patient's other health issues - generally the farther down the body the harder it is to heal (feet harder than trunk for example). Patients with poor circulation due to vascular disease (narrowed blood vessels), heal less well; diabetics generally heal less well; and some medical conditions like auto immune diseases (rheumatoid arthritis, lupus, etc) are often on medicines that slow healing.

The American Joint Commission on Cancer or AJCC has a staging system for all cancers including melanoma. Using melanoma thickness, the presence or absence of lymph node metatstasis and presence or absence of systemic (body) spread, the staging system will place you in a Stage that corresponds to a percentage of patients who survival for a specified time period (typically 5 years). This staging system is updated every few years to insure it has the latest data on melanoma. This is only for patients who have had a melanoma. As far as calculating your risk of getting a melanoma, there is no model where you plug in parameters and then get your chance of getting melanoma.

Accelerated Partial Breast Irradiation (APBI) has been around for almost 20 years but has gained in popularity over the past 10 years with the introduction of the Mammosite brachytherapy balloon catheter (which allowed easier treatment). The technique has been refined and modified over the last 10 years and now includes devices iwth multiple lumens (instead of the single catheter Mammosite), computerized 3-D CT treatment planning (originally treatment plans were done off plane X-Rays), and even APBI delivered by external beams not requiring any device placement within the breast. The future is bright for this 'targeted' treatment with shorter courses of treatment, intra-operative one dose treatments, and even 'CyberKnife' steroradiosurgical approaches (smaller beams of radiation from many different angles).

After the office consultation, I always have a surgical plan laid out for that patient. This usually includes widely excising the primary (skin) melanoma and often removal of the regional (draining) sentinel lymph nodes. The wide excision wound must be closed with either a skin graft or a flap (undermining of the skin surrounding the open wound in order to get the skin loose enough to stitch it back together). I then discuss this plan with my nurse who schedules the procedure and she will then go over the specifics/timings of the the pre-op tests (lymphoscintigraphy to map the skin and find the sentinel node) and the actual surgery day. The day of (or evening before) I review the chart and my plan of action.

The surgical oncologist will usually give the patient an estimate of the risk of the skin melanoma spreading to the sentinel (draining) lymph node. This risk varies by the thickness of the melanoma (the thicker melanoma, the greater chance of spread) and the presence of ulceration (ulcerated melanomas have greater chance of spread). Remember, the vast majority of melanomas have NOT spread to the sentinel nodes regardless of their thickness/ulceration. However, waiting for the pathology to return is always the hardest part of melanoma surgery (mentally). It usually takes 2-4 working days for the report to be finished so I tell everyone to try not to stress during this time (easy for me to say, hard for them to do).

Melanomas (and most cancers) are staged by 3 means - tumor, nodes, and distant metastases. For melanoma the 'tumor' is actually a measurement of the exact thickness of the melanoma measured in millimters. 'Thin' melanomas are less than 0.75 millimeter thick. The risk of spreading elsewhere (either to regional lymph nodes or throughout the body) is extremely low in 'thin' melanomas. Often, the removal of the sentinel lymph node (the lymph node that drains that patch of skin) is not done for thin melanomas but this will be a decision for you and your surgical oncologist.

Great question and really the 'Holy Grail' we are seeking. Foreign cells are foreign cells regardless if they are melanoma cells or kidney cells (from a transplant). The reason why the patient doesn't recognize their own melanoma cells as harmful and kill them is complex. First of all, the patient probably does recognize many different cancers as foreign and throughout their life, destroys them before they reach a point they are apparent to the patient or their doctor (this is a raging question in breast cancer right now - do screening mammograms pick up cancers that never become clinically apparent but which get lots of 'unnecessary' treatment). For unknown reasons (depressed host immunity, host immunity actually suppressing the host's ability to kill the melanoma [actually the basis of Yervoy - which lessened host suppression by removing T Suppressor cells], or the melanoma cells becoming 'smarter' at concealing themselves), the patient's melanoma will not be recognized as foreign and therefores grows unregulated.