Oncosurgical and dermatological approaches in diagnosis and treatment of patients with skin melanoma

Summary. In article two approaches are compared — one-step and two-step surgery in primary patients with skin melanoma. Oncosurgical (or one-step) approach consists in comprehensive preoperative diagnosis, which includes ultrasound measurement of tumor’s thickness, and cytological verification of melanoma. After that the radical surgery is performed — wide local excision of melanoma. Dermatological algorithm consists first of all in excisional biopsy of suspicious pigmented lesion. After histological verification of melanoma the second operation is carried out — wide local removal of postbiopsy scar, and sentinel node biopsy. Histologically no signs of melanoma are founded in scar tissue that creates illusion that distance of surgical removal of melanomas do not matter. But almost in quarter of patients seen lymph node metastases, suggesting that excisional biopsy initiating mechanisms of metastasis. From clinical point of view the comparison of two approaches showed expediency of one-step surgery instead of two-step surgery in treatment of primary skin melanomas.