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To the Editor.—
The rationale for surgical excision as the optimal treatment of choice for any malignant process is based on the assumption that the lesion originated in a defined area and continues to exist as a localized process for some variable although undeterminable period of time. During this period of localized growth, the potential for dissemination may or may not exist. Prior to the time that metastases do occur, however, the disease is presumably curable by local surgical extirpation and no treatment of the regional lymph nodes is necessary or warranted.When any originally confined cancer has ceased to be a localized process it is still potentially surgically curable provided that (1) the metastases have remained limited to the regional lymph nodes and (2) these nodes are accessible to surgical extirpation. The determination that dissemination has progressed to, but no further than, the local draining nodes is necessary at
Futrell JW. One Giant Leap for Mankind. JAMA. 1973;225(10):1247. doi:10.1001/jama.1973.03220380058020