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Less Is More
June 25, 2012

What the Surgeon Should Have Said to My Patient With Thin Malignant Melanoma

Author Affiliations

Author Affiliations: The SouthEast Alaska Regional Health Consortium (SEARHC), Ethel Lund Medical Center, Juneau (Dr Benjamin); and Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel (Dr Froom).

Arch Intern Med. 2012;172(12):906. doi:10.1001/archinternmed.2012.1246

A 46-year-old man incidentally discovered a pigmented lesion near the medial edge of his right scapula. There were no palpable lymph nodes. The biopsy revealed a malignant melanoma with favorable prognostic indicators: 0.5 mm deep, with focal infiltration of the papillary dermis; less than 1 mitosis per mm2; no ulceration; and areas with reactive lymphocytic and plasma cell infiltration (99% chance of 10-year survival1). A renowned surgical oncologist recommended wide excision with sentinel lymph node biopsy, saying,

It is up to you, but you have a risk that there is spread into your lymph nodes. It has been shown that patients with nodal disease operated on at an early stage do better than those having total lymph node resection at a later stage when an enlarged lymph node is palpable. By doing this procedure, I could save your life.