By Moshe Schein MD, FACS, FCS (SA), Leslie Wise MD, FACS, FRCS (Eng) (auth.)
"When a specific thing ceases to be a subject matter of controversy, it ceases to be a subject matter of curiosity. " WILLIAM HAZLITT (1778-1830) this can be the fourth quantity in a sequence which we began in 1997. In 1976, Varco and Delaney edited a "surgical bestseller" entitled Controversy in surgical procedure. This was once fol lowed by way of a moment quantity in 1985. The big good fortune of those books between either surgical trainees and skilled surgeons, and their vast overseas ap peal, supported the editors' idea view of controversy is critical to coach ing. notwithstanding, regardless of significant advances in surgical technology and perform, no different related booklet has considering that been prepare with the target of addressing significant controversies in surgical procedure. the purpose of this sequence is to deal with such deficiency by means of overlaying the main an important present controversies more often than not, vascular and trauma surgical procedure. considering the fact that nearly every thing is arguable in surgical procedure, we will take on diverse concerns virtually every year. The editors have chosen a nationally/internationally famous authority for every subject. so much books to be had this present day are both "North American:' "British-Com monwealth" or "British-European:' contributing to the consistent transatlantic rival ry. Our sequence particularly goals to bridge this "culture hole" and contains North American, British, eu, and different authors whereas preserving a cohesive constitution. this may expectantly additionally increase the allure of any such booklet throughout each side of the Atlantic and beyond.
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Additional info for Controversies in Surgery: Volume 4
However, there is strong evidence to indicate that radiation therapy is a valuable alternative on rare occasions, such as large facial lentigo maligna melanomas, which may involve wide surgical resection and extensive reconstruction, medically inoperable patients, or those who refuse surgery. Radiation has been used as a supplement to limit the extent of excision and thereby reduce cosmetic deformity. A number of studies have defined subsets of melanoma patients at high risk for local recurrence post-surgery, such as thick melanomas or desmoplastic melanomas, who might benefit from adjunctive therapy for the primary tumor bed.
Nonsurgical Modalities 33 To clarify the question, larger trials were conducted within cooperative groups. The largest multicenter, randomized trial was performed by the World Health Organization (WHO) and included 761 evaluable patients with Clark's level III-V truncal primaries and pathologically negative lymph nodes or with primary lesions from any other site with positive lymph nodes . Patients were randomized into four groups including DTIC alone, BCG alone, DTIC + BCG, or observation.
Intraoperative lymphatic mapping may be another way to further evaluate patients with thin melanomas whose primary tumors have poor prognostic features. Although there are currently no data to suggest that this group of patients would receive a survival benefit from a therapeutic lymph node dissection based upon a positive sentinel lymph node, they would be candidates for adjuvant therapies either in the form of interferon or immunotherapy trials. Some of these patients may also qualify for the Multicenter Selective Lymphadenectomy Trial, which would enroll patients with melanomas greater than 1 mm or patients with thin melanomas if they have a discordant Clark level of IV or V.