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BASICS IN DERMATOLOGIC SURGERY
One step melanoma surgery is possible also in cases with thick melanomas:
1) when there is already a tumour spread and there is no sense to
Perform SLN biopsy and
2) when patient disagree personally and with his signature for SLN removal for example.
One-step melanoma surgery (OSMS) for thick melanomas is an innovative approach where the melanoma is removed in a single surgical session, guided by preoperative assessments like ultrasound-measured tumor thickness and lymph node status. This personalized strategy, applicable to thicker tumors (over 4mm), aims to improve outcomes by ensuring appropriate margins while minimizing the need for a second surgery, which can reduce recurrence risk and financial burden.

How it works
Preoperative assessment: Before surgery, doctors use techniques like high-frequency ultrasound to measure the melanoma’s thickness and assess the nearby lymph nodes. Confocal microscopy may also be used.
Single surgical session: Based on the preoperative assessment, the surgeon plans the surgical margins and removes the melanoma and surrounding tissue in a single procedure.
Simultaneous lymph node evaluation: Depending on the risk, this single session can also include a sentinel lymph node biopsy to check if the cancer has spread to the lymph nodes.
Advantages for thick melanomas
Appropriate margins: By using preoperative data, the surgery can ensure the correct surgical safety margins are achieved from the start.
Avoids re-excision: This approach can eliminate the need for a second surgery, which is often required when follow-up histological analysis determines that the initial margins were insufficient.
Potential benefits: Patients may experience fewer adverse effects, reduced financial costs for the patient and the healthcare system, and a potentially lower risk of recurrence.
Important considerations
Not always an option: While OSMS is being explored for thicker melanomas, traditional guidelines still often call for a second surgery after initial histological results are available.
Requires specialized centers: Applying this approach requires specialized centers with access to technologies like high-frequency ultrasound for accurate preoperative assessment.
Individualized treatment: The decision to use OSMS should be made on a case-by-case basis after a thorough discussion between the patient and their healthcare team.
Because of distal tumour spread and a clinical and dermatoscopical suspicion for Thick Melanoma, a wide surgical excision without a SLn biopsy has been performed. Patient agreement and signature also important in that case.