Melanoma
Melanoma represents almost 100,000 cases of skin cancer diagnosed annually in the United States. While very curable, if caught early, it accounts for 75% of skin cancer related deaths. Its incidence appears to be increasing. The treatment of melanoma depends on the tumor depth and stage. The mainstay of melanoma treatment is early detection followed by a skin biopsy. An excisional biopsy will determine the depth of the melanoma and will guide Dr. Karimipour in the course of treatment. Many melanomas can be treated with a simple office surgery performed under local anesthesia. Thick and more advanced melanomas require more extensive surgery that must be performed in a hospital under general anesthesia. Dr. Karimipour is an expert in melanoma diagnosis, counseling, and treatment.
Excision for Melanoma
If caught early, an excision is used to remove the melanoma along with a margin of healthy skin around the melanoma. The width of the margin depends on the depth of the melanoma. The specimen is then sent to an outside dermatopathologist who has specialty training in reviewing melanoma specimens. If caught early, no further treatment is needed, however, patients will be educated on lifelong melanoma prevention techniques and the importance of self exams. Dr. Karimipour can assist with routine melanoma follow up if the patient does not have a dermatologist.
Staged Square Excision for Melanoma of the Head and Neck
Melanoma of the head and neck is generally treated using a "square" procedure which is a staged excision technique through which Dr. Karimipour can view 100 % of the peripheral margins around a melanoma. This technique involves the skin around the melanoma being sent to an outside pathology specialist known as a dermatopathologist who will view 100 % of the peripheral margins and will ensure all margins are clear. If any of the skin around the melanoma is positive for cancerous cells, Dr. Karimipour will know exactly where he has to remove additional skin. This technique looks at 100 % of the margins while conserving as much healthy tissue as possible.
There are two types of "square excisions":
* Peripheral Square - is a geometric, peripheral skin excision in which 100 % of the margins are reviewed by the dermatopathologist. The center
is empty space, representing the central lesion remaining on the patient and will be reviewed separately. Peripheral squares are useful in situations
where excising the lesion completely would result in a high likelihood of a positive margin and immediate reconstruction might inappropriately use
available lax skin.
* Central Excision - is the skin contained within the center of a peripheral square. The only important margin is the deep, as the periphery has
already been cleared. This deep margin will be reviewed by the dermatopathologist.
* Full Square - is a combination of the two terms above. The peripheral and central deep margins around the melanoma are assessed in a single procedure. This is
useful in situations where the likelihood of obtaining a "clear margin" is high and there is abundant lax skin in the area making reconstruction
straightforward.
There are two types of "square excisions":
* Peripheral Square - is a geometric, peripheral skin excision in which 100 % of the margins are reviewed by the dermatopathologist. The center
is empty space, representing the central lesion remaining on the patient and will be reviewed separately. Peripheral squares are useful in situations
where excising the lesion completely would result in a high likelihood of a positive margin and immediate reconstruction might inappropriately use
available lax skin.
* Central Excision - is the skin contained within the center of a peripheral square. The only important margin is the deep, as the periphery has
already been cleared. This deep margin will be reviewed by the dermatopathologist.
* Full Square - is a combination of the two terms above. The peripheral and central deep margins around the melanoma are assessed in a single procedure. This is
useful in situations where the likelihood of obtaining a "clear margin" is high and there is abundant lax skin in the area making reconstruction
straightforward.
