Behandling av malignt melanom : En studie av kirurgiske reseksjonsrender

Abstract

Summary in English:

The incidence of malignant melanoma is increasing in most parts of the world. The reason for this seams to be related to sun exposing and change in sun habits especially among young people. There is no cure for the disease except from surgery. For successful treatment early detection is important. There has been some discussion about how to perform this. The topic of the discussion has been about how large the excision margin shall be. Historically, specimens lager than 5 cm in dimension were removed because of the contention that a larger excision would provide optimal outcomes in terms of local recurrence rate and survival. This radical excisions had a high morbidity and usually required skin grafting. More recent studies has suggested that more conservative excision margins is equivalent regarding survival and recurrence. In this paper we have taken a closer look at some of the newest research done on the topic and compared this to the national and international guidelines that exist . We used the Cochrane base and Medline to find the articles we wanted to base our research on. We ended up with four randomized trials and one systematic review article on the topic. Most of the work has been done on malignant melanoma lesser than 2mm in thickness, only one of the articles cover melanomas thicker than 2mm. The studies done on the subject compare a conservative with a more radical excision margin regarding to both local and distant recurrence and survival. The results seems to be equal for all the studies we have looked at, there seems to be an significant difference between treatment with an wide and a more narrow excision margin. One of the studies conclude with a higher incidence in local and regional recurrence, but no difference regarding to survival. The national guidelines here in Norway seems to be well updated when we compare them to the studies we looked at. On this basis there should not be any reason to change the guidelines for treatment of malignant melanoma used today.