22. Malignant melanoma—wide/deep excision

 
Quotation from the 9th edition of Lever's:
 
"Formerly, the margin of resection of the primary tumor was regarded by most authors as optimal at about 5 cm beyond the perimeter of the lesion. However, a narrower margin is now acceptable.X A critical review of the literature revealed no evidence of an adverse effect on outcome in terms of survival from melanoma with narrowing of margins to 1cm."
 
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
 
Statements contrary by ABA:
 
" 'How wide and deep is deep enough for excision of malignant melanoma?' The answer was just enough to remove the melanoma completely, a principle that applies equally, in theory, to all malignant neoplasms in every organ and, of course, to every biopsy that seeks also to excise a neoplasm in situ.XIt makes no sense to perform a wider excision for a thicker primary melanoma; if a surgeon wants to take more tissue, he/she should go deeper, not wider!"
 
Cole RN, Ackerman AB. Guidelines for care of primary cutaneous melanoma: a critique of the current policy of the American Academy of Dermatology. Dermatopathology: Practical & Conceptual 9(4), 2003.
 
Other works of ABA in which the ideas contrary are expressed:
 
1. Exploding Myths: Melanocytic Neoplasms (video). In www.derm101.com, 2005.
 
2. Ackerman AB. Mythology and numerology in the sphere of melanoma. Cancer 88(3):491-96, 2000.
 
3. Ackerman AB. A centimeter here, a centimeter there. J Am Acad Dermatol. 8:279, 1996.
 
4. Ackerman AB, Scheiner AM. How wide and deep is wide and deep enough? Hum Pathol. 14:743-744 (September) 1983.