[size=20px]You are evaluating a 12-year-old girl with a pigmented lesion of the trunk. A dermatologist did a punch biopsy that revealed a conventional melanoma with a Breslow depth of 2.2 mm. The next best step in management is:

 

A Wide local excision (1 cm margins) and sentinel lymph node biopsy

 

B CT chest, MRI brain, and PET CT

 

C Initiation of neoadjuvant monoclonal antibody-based therapy

 

D Wide local excision (2 cm margins) and sentinel lymph node biopsy[/size]

D

D

D

B

B

D

D

Correct answer

D Wide local excision (2 cm margins) and sentinel lymph node biopsy

 

Based on the Breslow depth of 2.2 mm a wide local excision with a margin of 2 cm is required as well as a sentinel lymph node evaluation and biopsy. A completion lymph node dissection may be indicated based upon the number of involved nodes and nodal beds identified. If nodal involvement is identified a metastatic workup should be done. Adjuvant therapy would be indicated if nodal or distant metastases are identified.