Comparative Analysis of the "Scholastic" Recommendations of the AJCC From 2011 for the Surgical Treatment of Cutaneous Melanoma with the Newly Suggested Guidelines for OSMS From the Bulgarian Society For Dermatologic Surgery!

Background: The American Joint Committee on Cancer (AJCC) offers a two-stage, often insufficient or so-called variable model of cutaneous melanoma treatment. This model starts with primary excision and an initial operational safety margin of 0.5 cm in all directions, followed by a re-excision with an additional field of operational security, determined by histologically established tumor thickness (with or without removal of SLN). We present a brand new method of melanoma surgery, the so-called One Step melanoma surgery (OSMS), in which cutaneous melanomas (regardless of their thickness) could be removed by single surgical intervention.

Case Report: We describe a case of a patient with cutaneous melanoma, with postoperatively established Breslow's tumor thickness of 6 mm, operated on the AJCC model within two surgical sessions. The usual primary excision was performed with a surgical safety margin of 0.5 cm in all directions, followed by a secondary excision with an additional surgical security field of 1.2 cm in all directions (due to the patient's wish for the optimal cosmetic result, agreed and approved by the dermatosurgeon performing the manipulation).

Conclusion: The two-stage method for the treatment of melanomas is often insufficient due to: 1) the inability (in this case) secondary excision in the face area to be conducted with an additional recommended operational security field of 1.5 cm in all directions; and 2) the patient's wish for a better cosmetic result, which should be achieved with less surgical security field, resulting in a compromise solution for re-excision with an additional surgical field of 1.2 cm in all directions.