The evolution of the management of regional lymph nodes in melanoma.

The last two decades have seen sweeping changes in the surgical approach to melanoma. Traditionally, patients without evidence of nodal metastases were considered for elective lymph node dissection. This approach placed many patients at risk of morbidity while many derived no benefit. As investigators gained a deeper understanding of melanoma and lymphatic biology, newer methods of managing regional lymph nodes were sought. The advent of sentinel node biopsy has radically changed the approach to melanoma.