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Amy Ly, Jill C. Ono, Kevin S. Hughes, Martha B. Pitman and Ronald Balassanian

for MGH-CB and BWH-CB patients, respectively ( P =.10). Pathology Figure 1. Breast biopsy diagnosis in MGH patients treated with surgical excision after 1 FNAB. Abbreviations: DCIS, ductal carcinoma in situ; FEA, flat epithelial atypia; FNAB

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Daniel G. Coit, Robert Andtbacka, Christopher J. Anker, Christopher K. Bichakjian, William E. Carson III, Adil Daud, Raza A. Dilawari, Dominick DiMaio, Valerie Guild, Allan C. Halpern, F. Stephen Hodi Jr., Mark C. Kelley, Nikhil I. Khushalani, Ragini R. Kudchadkar, Julie R. Lange, Anne Lind, Mary C. Martini, Anthony J. Olszanski, Scott K. Pruitt, Merrick I. Ross, Susan M. Swetter, Kenneth K. Tanabe, John A. Thompson, Vijay Trisal and Marshall M. Urist

disease. Other blood work may be performed at the discretion of the treating physician. Treatment of Primary Melanoma Wide Excision Surgical excision is the primary treatment for melanoma. Several prospective randomized trials have been

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Grant A. McArthur

and controversies . Int J Dermatol 2005 ; 44 : 893 – 905 . 25. Gloster HM Jr Harris KR Roenigk RK . A comparison between Mohs micrographic surgery and wide surgical excision for the treatment of dermatofibrosarcoma protuberans . J Am

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Parijatham S. Thomas

in situ (DCIS) contains similar histologic features to ADH but tends to be more extensive. Since differences in diagnosis of ADH or DCIS is dependent on the extensiveness of disease, surgical excision is often recommended for a definitive diagnosis

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Hillary Johnson-Jahangir, William Sherman and Désirée Ratner

metastasis, because the lung is the most common site of spread. 6 – 8 Surgical excision with careful margin evaluation is the preferred treatment for DFSP. Low recurrence rates have been shown after Mohs micrographic surgery (MMS) or wide local excision

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Tejaswi Mudigonda, Daniel J. Pearce, Brad A. Yentzer, Phillip Williford and Steven R. Feldman

affects chronically sun-exposed sites, including the trunk and upper extremities, and particularly the head and neck. 19 The 5-year recurrence rate for traditional surgical excision is 10.1% for primary BCC 20 and from 10.9% to 18.7% for SCC. 21 The 5

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Frank Qian Zhan, Vathani Sharon Packianathan and Nathalie Charlotte Zeitouni

–393 . 63 Gillenwater AM Hessel AC Morrison WH . Merkel cell carcinoma of the head and neck: effect of surgical excision and radiation on recurrence and survival . Arch Otolaryngol Head Neck Surg 2001 ; 127 : 149 – 154 . 64 Veness MJ

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Daniel G. Coit, Robert Andtbacka, Christopher K. Bichakjian, Raza A. Dilawari, Dominick DiMaio, Valerie Guild, Allan C. Halpern, F. Stephen Hodi, Mohammed Kashani-Sabet, Julie R. Lange, Anne Lind, Lainie Martin, Mary C. Martini, Scott K. Pruitt, Merrick I. Ross, Stephen F. Sener, Susan M. Swetter, Kenneth K. Tanabe, John A. Thompson, Vijay Trisal, Marshall M. Urist, Jeffrey Weber and Michael K. Wong

Melanoma Clinical Practice Guidelines in OncologyNCCN Categories of Evidence and ConsensusCategory 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus.Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus.Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement).Category 3: The recommendation is based on any level of evidence but reflects major disagreement.All recommendations are category 2A unless otherwise noted.Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.In 2008, an estimated 62,480 new cases of melanoma will have been diagnosed and approximately 8420 patients will have died of the disease in the United States.1 However, these projections for new cases may represent a substantial underestimation, because many superficial and in situ melanomas treated in the outpatient setting are not reported. The incidence of melanoma continues to increase dramatically. Melanoma is increasing in men more rapidly than any other malignancy and more rapidly in women than any other malignancy except lung cancer. For someone born in the United States in 2005, the lifetime risk for developing melanoma may be as high as 1 in 55.2 Melanoma ranks second to adult leukemia in terms of loss of years of potential life, per death. The median age at diagnosis is 59 years.Risk factors for melanoma include...
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Samuel W. Beenken and Marshall M. Urist

Merkel cell carcinoma (MCC) or neuroendocrine carcinoma of the skin is uncommon, often aggressive, and has a poor prognosis. Complete surgical excision with histologic documentation of clear resection margins is recommended for the primary cancer. Retrospective analysis of clinical data strongly suggests that adjuvant radiotherapy improves local control of MCC, but no evidence has been published that it prolongs survival. Sentinel lymph node biopsy is a useful method of determining the need for regional lymph node dissection in stage I patients. Chemotherapy regimens similar to those employed for small cell carcinoma of the lung have been recommended for advanced MCC. Patients often show an initial response to therapy, but it is usually short-lived. The three-year overall survival for patients with MCC is 31%. Before an improvement in long-term survival can be realized, early detection, appropriate use of surgery and radiation therapy, and the development of effective systemic chemotherapy are required.

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Scott M. Schuetze and Michael E. Ray

Wide surgical excision is the backbone of therapy for localized soft tissue sarcoma and often produces excellent results. Patients with a marginal resection of disease and high-grade or large tumors are at an increased risk of recurrence. Radiation therapy (external beam or brachytherapy) has been shown to reduce the risk of local recurrence of disease and should be offered to patients with large (>5 cm) or high-grade sarcomas, especially if a wide resection cannot be performed. Use of preoperative versus postoperative radiation therapy should be planned, in consultation with a radiation oncologist and a surgical oncologist, before resection of the sarcoma if possible. Chemotherapy using an anthracycline- and ifosfamide-based regimen may improve disease-free and overall survival rates. Chemotherapy appears to be most beneficial for patients with very large (≥10 cm), high-grade sarcomas of the extremity who are at a high risk of experiencing distant recurrence of disease. The effect of adjuvant chemotherapy on overall survival remains controversial. Research is greatly needed to identify the patients who are most likely to benefit from conventional chemotherapy, improve the treatment of retroperitoneal sarcomas, and identify novel agents that may impact the natural history of high-risk soft tissue sarcoma.