The debate over immediate lymph node dissection in melanoma.

The World Health Organization report has not dissuaded me from still believing that it is not in the best interest of the patient to allow regional lymph nodes draining an advanced primary melanoma, such as a thick level 5 nodular lesion, to go untreated and to be exposed to a wait and see philosophy. Whether the nodes are treated by excision or regional perfusion is probably unimportant. What is of importance is that clinicians in their own respective areas of the world continue to look critically at the concept of biologic determinism of regional lymph nodes in patients with advanced Clark-Breslow melanoma.