Elsevier

The Lancet

Volume 169, Issue 4362, 6 April 1907, Pages 927-933
The Lancet

The Bunterian Lectures ON THE PATHOLOGY OF MELANOTIC GROWTHS IN RELATION TO THEIR OPERATIVE TREATMENT.

Delivered before the Royal College of Surgeons of England on Feb. 25th and 27th, 1907, BY W. SAMPSON HANDLEY, M.S. LOND., F.R.C.S. ENG., HUNTERIAN PROFESSOR; ASSISTANT SURGEON TO THE MIDDLESEX HOSPITAL.
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References (2)

  • Brit. Med. Jour.

    (July 28th. 1906)
  • Gaylord

    Medical Record

    (Oct. 28th, 1906)

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    Waldeyer et al. suggested that a local disturbance of connective tissue was an essential prelude to tumor growth [2]. In 1907 Handley described that a “round cell infiltrate” indicated a regressive process in melanoma [3], which was reinforced by Wade et al. when he described a regressing transplanted canine sarcoma as “the tumor being borne away on a lymphocyte tide” [4]. In 1912 De Fano concluded from a study on murine tumor grafts that a peritumoral infiltration of lymphocytes and plasma cells was an expression of a defensive mechanism akin to immunity [5].

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    In 1892, he was the first to emphasize the importance of “anticipatory gland dissection” as a safe and easy procedure.5 Similar to Snow's approach, in 1907, William Sampson Handley of London Hospital, advocated the importance of wide excision of the primary melanoma in combination with elective regional lymph node dissection or possibly amputation in select cases.6 During the first 160 years from the initial systematic description of melanoma, the building blocks for (surgical) management of this disease were established, and the significant challenges in the management of patients with advanced disease soon became evident.

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    Indeterminate findings suspicious for metastases on any scan are investigated further and confirmed cytologically or histologically using image-guided needle aspiration biopsy. The propensity of melanoma to disseminate and recur locally is well documented and has historically influenced the surgical approach to this tumor.59,60 The surgical treatment of melanoma in terms of margin excision width has been studied extensively in prospectively randomized trials.

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    The routine use of such wide margins of resection frequently necessitated skin grafting to cover the defect and increased the morbidity of the resection. More than 100 years ago, Handley12 published his treatment of locally advanced cutaneous melanoma with wide (up to 5 cm) margin excision, and the exclusive use of wide margin resection for all melanomas has been routinely, although not necessarily correctly, attributed to him. Decades later, pathologic findings of atypical melanocytes present at the periphery of melanomas, several centimeters away from the primary tumor, added to the belief that a minimum of 5-cm margin of excision was mandatory for adequate surgical treatment of melanoma.13

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