Melanoma
Wide excision, sentinel lymph node biopsy and coordination with immunotherapy
Melanoma is the most serious common skin cancer, and the surgery that follows a diagnosis determines both whether the cancer is fully removed and how it is staged. Dr. Papenfuss performs wide excision and sentinel lymph node biopsy for melanoma in Milwaukee and coordinates with dermatology and medical oncology for patients who need more than surgery. He sees patients from across Wisconsin.
What it is
Melanoma starts in the pigment cells of the skin. It is usually found as a changing mole or a new dark spot and confirmed by a skin biopsy, often by a dermatologist. The thickness of the melanoma on that biopsy (Breslow depth), whether it is ulcerated, and how many cells are dividing determine the next steps. Melanoma can spread first to nearby lymph nodes, which is why evaluating the nodes is part of treatment for anything beyond the thinnest lesions.
How it is treated
Wide local excision: removing the melanoma site with a margin of normal skin, 1 to 2 cm depending on thickness, to make sure no cancer is left behind. Often done as an outpatient; larger defects may need a plastic surgery closure.
Sentinel lymph node biopsy: a dye and tracer injected at the melanoma site identify the first node or nodes the cancer would drain to, which are removed and examined. Recommended for melanomas thicker than about 0.8 mm or with high-risk features. It is the most accurate way to stage melanoma and guides whether drug therapy is recommended.
Lymph node dissection for patients with clinically enlarged, cancer-containing nodes.
Immunotherapy and targeted therapy after surgery for stage III melanoma, and as the main treatment for stage IV, through medical oncology. These drugs have transformed melanoma outcomes in the past decade.
Surgery for metastases in selected patients, where removing a limited number of deposits adds to systemic therapy.
Dr. Papenfuss's approach
Dr. Papenfuss works closely with dermatology for diagnosis and skin surveillance, and with medical oncology so that patients who need immunotherapy begin it promptly after surgery. Sentinel node mapping is coordinated with nuclear medicine on the day of surgery. Melanoma cases with nodal or distant disease are reviewed with the multidisciplinary team, and patients are offered clinical trials where appropriate.
When to get a second opinion
If a melanoma was removed without discussion of margins or sentinel node biopsy, or if you have positive nodes and want to understand surgery versus immunotherapy options, a surgical oncology review is reasonable.
Call 414-649-3240 to request a consultation.
This page is general information, not medical advice for any individual patient.