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ID Design 2012/DOOEL Skopje, Republic of Macedonia

Open Access Macedonian Journal of Medical Sciences.


eISSN: 1857-9655

Expert Opinion




New Safety Margins for Melanoma Surgery: Nice Possibility for Drinking of "Just That Cup of Coffee"?


Georgi Tchernev1*, Anastasiya Atanasova Chokoeva2


1Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria; 2Onkoderma”- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria





BACKGROUND: The American Joint Committee on Cancer (AJCC’s) skin melanoma surgical treatment recommendations from 2011 are characterised by a prima facie "freedom of choice" regarding how extensive should be the excisions for melanomas with tumour thickness up to 2 mm and melanoma in situ. It is unclear why the recommended surgical security margins vary between 0.5 and 1 cm for melanoma in situ, whereas for melanomas with a tumour thickness of up to 1.99 mm, the range of variation is also between 1 and 2 cm, without specifying when the surgical field should be broader and, narrower, accordingly. This "uncertainty or lack of intent" of the guilders often leads to the same surgical approach to melanomas at different stages, or to a different approach in cases of melanomas at the same stage, in contrast. Therefore, this should be defined as wrong, logically.

CASE PRESENTATION: We present 3 patients with cutaneous melanomas, treated with similar fields of surgical security. Current issues, generated within the framework of melanoma’s surgery guided by the recommendations of the AJCC are also discussed. A new surgical approach in patients with melanoma is recommended, discussed for the first time in world literature. We hypothesize that the introduction of a certain recommendations for a 2 cm surgical field in all directions during the initial excision, combined with the parallel performance of a sentinel lymph node biopsy, will lead in fact to several important advantages: 1) avoiding of the secondary excision in at least 70% - 90% of the patients (depending on the tumor thickness), 2) minimizing the risk of lymphatic effusion change and misinterpretation of the sentinel lymph node biopsy’s results in patients with secondary excision; 3) optimization of the surgical team’s work; 4) minimizing the possibility of unprepared/uninformed personnel to take part in decisions for treating a specific disease such as skin melanoma, 4) facilitating the appropriate patients’ group selection at the appropriate stage when involving them in different studies, leading to equal leveling of the initial positions;

CONCLUSION: Whether the proposed approach will be subjected to a detailed discussion of AJCC’s expert’s remains currently unclear.


Citation: Tchernev G, Chokoeva AA. New Safety Margins for Melanoma Surgery: Nice Possibility for Drinking of "Just That Cup of Coffee"? Open Access Maced J Med Sci. https://doi.org/10.3889/oamjms.2017.068
Keywords: melanoma; staging; surgical field margins; prognosis; variety.
*Correspondence: Georgi Tchernev. Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria. E-mail: georgi_tchernev@yahoo.de
Received: 13-Apr-2017; Revised: 29-Apr-2017; Accepted: 14-May-2017; Online first: 11-Jun-2017
Copyright: 2017 Georgi Tchernev, Anastasiya Atanasova Chokoeva. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
Funding: This research did not receive any financial support.
Competing Interests: Publication of this paper has been supported by Roche Macedonia DOOEL Skopje.


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- Chokoeva AA




Published by: Id Design 2012/DOOEL Skopje, Republic of Macedonia

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.