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Modern technologies in surgical treatment of cutaneous malignant melanoma


Author: Ţurcan Stela
Degree:doctor of medicine
Speciality: 14.00.14 - Oncology and Radiotherapy
Year:2009
Scientific adviser: Ion Mereuţa
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Iraida Iacovleva
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Oncology
Institution:
Scientific council:

Status

The thesis was presented on the 3 March, 2009
Approved by NCAA on the 23 April, 2009

Abstract

Adobe PDF document0.57 Mb / in romanian

Thesis

CZU 616.5-006.81-089

Adobe PDF document 2.52 Mb / in romanian
101 pages


Keywords

melanoma, surgical treatment, the limits of electoexcision, vacuum-excision, reccurence, metastasis, management, monitoring

Summary

Cutaneous melanoma is a malignant tumor, sometimes with aggressive unpredictable evolution. The patients (232) subjected to the study have been devided into 3 groups. The first study group included 76 patients with primary melanoma, surgically treated by the method of determination of excision limits. The second study group constitued 76 patients surgically treated by vacuum-electroexcision. The witness group included 80 patients treated by the usual method (retrospective study). We performed this research in order to elaborate and put into practice modern surgical technologies which increase the efficiency of the surgical treatment of CMM. Analysing the research results, it has been established that in the first group the electroexcision limits of the primary tumor constituted 1,1–1,5cm (48,5±5,7% (p<0,01)) from the border line of the cutaneous primary melanoma. The limits of electroexcision have been appreciated in the preoperative period particularly in each patients using mathematical modeling on the basis of ultrasound and thermographic results. Using the vacuum-electroexcision in the second group, it has been established that the incision of the skin constitued 1,6-2,0cm (36,8±5,5% (p<0,001)) from the border line of the tumor. After operation, the primary tumor and the excised tissues have been studied morphologically. It has been established that primary melanoma was removed in the limits of healthy tissues in 97,8±1,7% (p<0,001) in the first study group and 98,0±1,2% (p<0,001) in the second study group. During 5 years, local recurrences haven’t been discovered at patients in the second group (RR=0), in comparation with 8,7±5,0% (p<0,05) in the witness group. We have also studied the metastatic tumors in both groups. The frequency of metastasis in the second group is 56,5±7,6% (p<0,001) and 68,7±6,3%(p<0,001) in the witness group, which is 1,2 times greater. The survival during 5 years constituted 68,2% for patients in the second group in comparison with 48,7% in the witness group. There have been analysed the results of the cicatrization of postoperative wounds, using the elaborated methods. It has been established, that primary cicatrization is 1,6 times higher in the first and second group than in the witness group (RR=1,6 95% IÎ:1,2-1,9).

The results obtained on the basis of the research allowed us to elaborate methodical recommendations for students, residents, doctors specialists, oncologists and to create a Center of monitoring and treatment of malignant melanoma, as well as a Register of the patients and families with melanoma. The results of the thesis will be used to increase the efficacy of the surgical treatment and to optimize the instructive process in the Chair of Hematology and Oncology of State Medical University “N. Testemiţanu” and Institute of Oncology.