Thousands of practice guidelines/practice parameters have been published by various professional organizations. The American Medical Association,[1] American College of Physicians,[2,3] and others[4-6] have written extensively about methodologic, quality, and cost considerations in relation to such guidelines. In the early 1990s, the Society of Surgical Oncology participated in the development of extensive evidence-based standards of care for breast conservation treatment of primary breast cancer patients.[7]
More recently, the Society undertook a more ambitious initiative aimed at developing surgical practice guidelines directed toward the evaluation and initial management of patients with signs and symptoms of cancer. These guidelines encompass the major cancer sites.
Scope and Format of the Guidelines
The Society of Surgical Oncology practice guidelines were based on detailed review by nationally recognized experts in their respective fields. Each guideline represents a consensus of multiple members of the Society of Surgical Oncology who are well known for their expertise. The authors have stressed the symptoms and signs of primary cancer without discussing screening programs. The guidelines also discuss the timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and the role of the surgeon in the diagnosis and treatment of cancer.
Separate sections on adjuvant therapy, follow-up programs, or management of recurrent cancer have been intentionally omitted. For many sites, perioperative adjuvant combined-modality therapy has been shown to improve outcomes. Where appropriate, such therapy is discussed under surgical management.
The guidelines are presented in minimal outline form as a delineation of therapeutic options. It is not the intent of these guidelines to define in detail all of the alternatives, risks, and outcomes for surgical or combined-modality therapy of the cancer patient. For most sites, the generally acceptable therapeutic options are defined.
Following each guideline is a brief narrative highlighting and expanding on selected sections of the guideline document, with a few relevant references. The current staging system for the site and approximate 5-year survival data are also included.
Previous issues of ONCOLOGY featured the Society of Surgical Oncology's practice guidelines on breast, lung, ovarian, and prostate cancers (June); colorectal, esophageal, gastric, and pancreatic cancers (July); and laryngeal, oropharyngeal and oral cavity, parotid, and thyroid cancers (August). This issue includes guidelines on melanoma and sarcoma.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
