Surgical treatment of cutaneous melanoma

Surgery still remains the only effective treatment of melanoma; the improvements in prognosis achieved are mainly due to early diagnosis and an extensive public education programme. Once the diagnosis of melanoma has been achieved, at least by an excisional biopsy, the first step is an accurate staging of patients in order to define the exact extent of the disease. For stage I patients it seems reasonable to perform a narrow excision (1 cm margins) for melanoma thinner than 2 mm; a wide excision (3-5 cm margins) is mandatory for thicker melanomas. The dissection of uninvolved regional lymph nodes is still a matter of discussion, in spite of the evidence of randomized studies in patients with melanoma of intermediate risk (1.5-4.0 mm). For stage II there is no doubt about the need for radical dissections of the basins involved. When the disease is located at a distance (stage III) the role of surgery is restricted to very select cases; in this event surgery is mainly palliative and only in very rare cases therapeutic.