Main Article Content
The majority of physicians treating melanoma in situ recommend a 5mm to 1cm margin with excision into the subcutaneous tissue extending between the superficial and the deep fat. There is always the potential for an unrecognized invasive component in a melanoma in situ, making aqueous zinc chloride solution an ideal agent to treat the excision wound of a melanoma in situ of the trunk and extremities. Zinc chloride solution penetrates deeply and widely, killing and fixing tissue when applied to the excision wound, facilitating the excision by allowing for a simple saucerized excision with a narrower and thinner margin while ensuring the treatment of any possible unrecognized invasive components. Zinc chloride has been used in a paste since 1835 to treat skin cancers and melanoma but unlike pastes zinc chloride in solution is recognized by the U.S. Food & Drug Administration as a generally safe substance (Code of Federal Regulations Title 21 [Part 182]). The solution penetrates as deeply and widely and effectively as in the paste which Mohs described to be an inactive vehicle for the active ingredient, zinc chloride solution. Mohs reported a large significant survival benefit (p=0.003) for invasive melanoma using surgery combined with zinc chloride over conventional melanoma surgery. Zinc chloride solution without the paste is a new medicine effective as a surgical adjuvant in the treatment of the excision wound of a melanoma in situ of the trunk and extremities. Zinc chloride can be used as a surgical adjuvant for any melanoma, but melanoma in situ of the trunk and extremities is the logical starting point for a physician interested in using this adjuvant in the treatment of melanoma. Zinc chloride is very powerful and potentially scarring and should be used on the excision wound of a previously histologically diagnosed melanoma only.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Defazio JL, Ashfaq A, Marghoob YP. Variation in the depth of the excision of melanoma a survey of US physicians. Arch Dermatol. 2010 Sep 20; 146(9): 995-999.
3. Mohs FE. Chemosurgery Charles C. Thomas: Springfield, 1978: 3-29, 153, 156, 175, 181, 207-209, 217, 225-248.
4. Brooks NA. Treatment of melanoma excision wound with 50% zinc chloride solution astringent – Mohs melanoma surgery without the paste. J Clin Aesthet Dermatol. 2020; 13(3):15-16.
5. Brooks NA. Fixed-tissue micrographic surgery in the treatment of cutaneous melanoma. An overlooked cancer treatment strategy. J Dermatol Surg Oncol. 1992;18:999-1000.
6. Mohs FE. Chemosurgery for melanoma. Arch Dermatol 1977; 113:285-91
7. Clark WH, From L, Bernardino EA, et al. The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Res 1969; 29:705-26.
8. Snow SN, Mohs FE, Oriba HA, et al. Cutaneous malignant melanoma treated by Mohs surgery: review of the treatment results of 179 cases from the Mohs melanoma registry. Dermatol Surg. 1997;23(11):1055-1060.
9. Brooks NA. Mohs Melanoma Chemosurgery Simplified to a Single Brief Caustic Application: Possible Vaccine Effect. Dermatologic Surgery. https://europepmc.org/article/MED/28595247 (2018)
10. Tohme S, Simmons RL, Tsung A. Surgery for cancer: A trigger for metastases. Cancer Res. 2017 April 01; 77(7): 1548-1552.
11. Horowitz M, Neeman E, Sharon E, et al. Exploiting the critical perioperative period to improve long-term cancer outcomes. Nature reviews Clinical oncology. 2015 Apr; 12(4):213-226.
12. Smolle J, Soyer HP, Smolle-Juttner FM, et al. Does surgical removal of primary melanoma trigger growth of occult metastases? An analytic epidemiological approach. Dermatol Surg 1997;23(11):1043-6.
13. Warr RP, Zebedee Z, Kenealy J, et al. Detection of melanoma seeding during surgical procedures--- an RT-PCR based model. Eur J Surg Oncol 2002;28(8):832-7.
14. Kunter U, Buer J, Probst M, et al. Peripheral blood tyrosinase messenger RNA detection and survival in malignant melanoma. J Natl Cancer Inst 1996;88(9):590-4.
15. Van der Bij GJ, Oosterling SJ, Beelen RH, et al. The perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer. Annals of surgery. 2009 May; 249(5): 727-734.
16. Qadri SSA, Wang JH, Coffey JC, et al. A. Can surgery for cancer accelerate the progression of secondary tumors within residual minimal disease at both local and systemic levels? Ann Thorac Surg 2005;80(3):1046-51.
17. Demicheli R, Retsky MW, Hrushesky WJ, et al. The effects of surgery on tumor growth: a century of investigations. Annals of oncology: official journal of the European Society for Medical Oncology/ ESMO. 2008 Nov; 19(11): 1821-1828.
18. Fortner JG. Inadvertent spread of cancer at surgery. J Surg Oncol. 1993 Jul;53(3): 191-6.
19. Alieva M, van Rheenen J, Broekman MLD. Potential impacts of invasive surgical procedures on primary tumor growth and metastasis. Clin Exp Metastasis. 2018; 35(4): 318-331.
20. Pachmann K. Tumor cell seeding during surgery---Possible contribution to metastasis formations. Cancers (Basel). 2011 Jun; 3(2): 2540-2553.
21. Murthy SM, Goldschmidt RA, Rao LN, et al. The influence of surgical trauma on experimental metastasis. Cancer. 1989 Nov 15; 64(10):2035-2044.
22. Koch M, Kienle P, Hinz U, et al. Detection of hematogenous tumor cell dissemination predicts tumor relapse in patients undergoing surgical resection of colorectal liver metastases. Annals of surgery. 2005 Feb; 241(2): 199-205.
23. Gresham E, Don Parsa F. Iatrogenic Implantation of Cancer Cells During Surgery. Hawaii J Health Soc Welf. 2020 Jan; 79(1): 4-6.
24. James A, Daley CM, Greiner KA. “Cutting” on cancer: Attitudes about cancer spread and surgery among primary care patients in the USA. Soc Sci Med. 2011 Dec;73(11):1669-1673.
25. Shyamala K, Girish HC, Murgod S. Risk of tumor cell seeding through biopsy and aspiration cytology. J Int Soc Prev Community Dent. 2014 Jan-Apr; 4(1): 5-11.
26. Berger-Richardson D, Xu RS, Swallow CJ, et al. Glove and instrument changing to prevent tumour seeding in cancer surgery: a survey of surgeon’s beliefs and practices. Curr Oncol. 2018 Jun; 25(3): e200-e208.
27. Nishizaki T, Matsumata T, Kanematsu T, et al. Surgical manipulation of VX2 carcinoma in the rabbit liver evokes enhancement of metastases. J Surg Res 1990;49(1):92-7.
28. Rushfeldt C, Sveinbjornsson B, Seljelid R, et al. Early events of hepatic metastasis formation in mice: role of Kupffer and NK-cells in natural and interferon-gamma-stimulated defense. The Journal of Surgical Research. 1999 Apr; 82(2): 209-215.
29. Scoggins CR, Ross MI, Reintgen DS, et al. Prospective multi-institutional study of reverse transcriptase polymerase chain reaction for molecular staging of melanoma. J Clin Oncol. 2006; 24:2849-57.
30. Kalish RS, Siegel DM, Brooks NA, et al. Experimental rationale for treatment of high-risk human melanoma with zinc chloride fixative paste. Dermatol Surg. 1997;23:1043-6.