Melanoma management continues to evolve, and plastic surgeons need to stay at the forefront of advances and controversies. Appropriate margins for in situ and invasive disease require consideration of the trials on which they are based. A workhorse reconstruction option for wide excision defects, particularly in extremities, is the keystone flap. There are alternative surgical approaches to subungual tumors besides amputation. It is now possible to personalize a risk estimate for sentinel node positivity beyond what is available for groups of patients with a given stage of disease. Sentinel node biopsy can be made more accurate and less morbid with novel adjuncts. Positive sentinel node biopsies are now rarely managed with completion lymphadenectomy. Should a patient require lymphadenectomy, immediate lymphatic reconstruction may mitigate the lymphedema risk. Finally, there are minimally invasive modalities for effective control of in-transit recurrences.

Learning Objectives
After viewing this course, the participant should be able to:

1. Discuss margins for in situ and invasive disease and describe reconstructive options for wide excision defects, including the keystone flap.
2. Describe a digit-sparing alternative for subungual melanoma.
3. Calculate personalized risk estimates for sentinel node biopsy using predictive nomograms.
4. Describe the indications for lymphadenectomy and describe a technique intended to reduce the risk of lymphedema following lymphadenectomy.
5. Offer options for in-transit melanoma management.

• Patient Care and Procedural Skills
• Medical Knowledge
• Practice-based Learning and Improvement

Accreditation
The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation
The ASPS designates this enduring material for a maximum of1.0AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Of the 1.0 credits, 0.5 have been identified as applicable to patient safety.   

AMA PRA Category 1 Credit^TM: 1.0
Patient Safety Credit: 0.5
Media:Journal Article, video
Release Date: 3/01/2023
Expiration Date: 3/01/2026
Estimated time to complete this course: 1 hour
*Course access ends on course expiration date

Disclosure Policy
The American Society of Plastic Surgeons (ASPS) requires all faculty, authors, planners, reviewers, managers, staff and other individuals in a position to control or influence the content of an activity to disclose all relevant financial relationships or affiliations. All identified conflicts of interest must be resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials.

Disclaimer: All relevant financial relationships for planners, faculty, and others in control of content (either individually or as a group) are reviewed by the ASPS Continuing Education Committee and have been mitigated, if applicable.

The following planners/faculty members/reviewers have no relevant financial relationships or affiliations to disclose:
Claire Temple-Oberle, FRCSC; Christine Nicholas, FRCSC; Priscila Rojas-Garcia, MD

Recognition Statement

The Continuing Medical Education (CME) credits offered by this activity are enhanced by ASPS Learner Credit Reporting for learners who have opted into this reporting. Successful completion of this CME activity enables active American Board of Surgery (ABS) members the opportunity to earn credit toward the CME requirement of the ABS's Continuous Certification program when claimed within 30 days of completion of the activity.

Participants in ASPS-accredited education who want their CME credits reported to certifying and state licensing boards must opt-into reporting and add their NPI as well as state license ID and/or collaborating board ID(s) before claiming credit.

Directly provided by the American Society of Plastic Surgeons® (ASPS®)