LOCAL FAILURE IN THE TREATMENT OF MELANOMA

Abstract

Inadequate treatment of melanoma delays definitive management and increases the hazard of dissemination to regional lymph nodes and distant organs. Adequate treatment of melanoma is followed by local failure in 9 percent of patients in Stage I, 21 percent in Stage II. Increased occurrence of local failure associated with melanoma of head and neck, fingers and soles of feet is probably due to inadequate excision. Local failure is more commonly observed after treatment of melanoma below than above the elbows and knees. Seventy-nine percent of local failures occur within the first 2 years of definitive surgery and among these cases mortality is high. When local failure occurs after 2 years, the opportunity for long term survival is enhanced. It may be possible to decrease the incidence of local failure by more adequate primary surgical treatment, but the most promising preventative of local failure is early recognition of melanoma and prompt surgical resection before lymphatic metastasis will have occurred.