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Fully analysed by a dermatologist. A biopsy may be taken to confirm diagnosis by histological examination, which is performed by a pathologist. buy generic viagra online If the skin lesion is removed and confirmed to be a melanoma, it is then assessed according to various staging systems. buy viagra over the counter london The staging system takes into account the radial growth phase, vertical growth phase, regional lymph node metastasis and distant metastasis of the melanoma. buy viagra without prescription There are about five stages, depending on the system used. viagra cost As the stage increases, so too does the severity of the melanoma. The stages used below correspond to those of the american joint commission on cancer. Can it be treated? viagra ice cream go sale selfridges The treatment for melanoma is initially, surgical excision of the primary tumour. buy viagra over the counter london Surgical excision should be curative for stages 1 and 2, however it is not curative for stages iii and iv because these involve metastasis. Patients with stage four have metastatic spread beyond regional lymph nodes. buy viagra over the counter london Surgical excision of initial melanoma plus any metastases is not curative, but can improve quality of life and prolong survival7. el viagra y alcohol Surgery to remove the regional lymph nodes should be performed in patients with a stage three or four melanoma. Some patients who are stage one or two and are free of lymph node involvement, yet are at high risk of metastasis, may have their lymph nodes removed as a preventative measure. cheapest viagra pills If lymph nodes are not removed, careful follow up is critical for early identification and treatment7. Regional lymph node status is important for prognosis, in predicting recurrence and survival after excision of initial melanoma. viagra canada online Patients with stage 1 or 2a melanoma do not require any further treatment after surgical excision of the melanoma. price of viagra at costco For patients with stage 2b and greater chemotherapy is required to eradicate any metastases. The drug of choice appears to be dacarbazine, although interferons are showing promise. buy generic viagra Isolated limb perfusion with melphalan has also shown benefit. Interferon -2b increases the overall survival period of remission for patients with. jet lag remedies viagra Charity number:1052607