One Step Surgery for Cutaneous Melanoma: “We Cannot Solve Our Problems with the Same Thinking We Used When We Created Them?”

Abstract

One step melanoma surgery is, in fact, an innovative combined method for diagnosis and treatment of cutaneous melanoma (at the same time). The methodology allows an accurate assessment of the actual status of the affected patients by 1) clinical status, dermatoscopy, high-frequent ultrasonography (HFUS) of the pigmented lesion (eventually in combination with normal lymph nodes ultrasonography), followed by a single surgical intervention. Within this intervention, the primary tumour is removed with the appropriate surgical field, with or without parallel detection and draining lymph node biopsy (depending on the established tumour thickness). Removal of the lymph node may, in turn, be associated with or without locoregional lymphadenectomy, which is determined by its macroscopic appearance, established intraoperatively or after the histopathological evaluation. The methodology is sparing, innovative, easy to apply, tested in its functionality and logically justified. For an unknown reason, this methodology is not applicable in melanoma treatment’s guidelines in Europe and America. In Bulgaria and France, however, there are centres and hospitals that apply the technique mentioned above with enormous results, in particular in Bulgaria, the methodology is getting more and more improved to the current moment. Based on the above, as well as on the scant experience, we may share the opinion that the current melanoma treatment’s guidelines need major corrections in their recommendations, which are not optimal for patients due to the following facts: (1) the adverse effects on patients as a result of the necessity of at least 2 surgical interventions; (2) the frequent occurrence of changes in the lymph flow after the primary excision; (3) the frequent non-obtaining of the suggested in the guidelines terms for re-excisions with or without sentinel lymph node removal; and (4) the creation of additional financial difficulties for the patients in the framework of two unneeded hospitalizations.