The surgical management of melanoma: from diagnosis to local treatment.

It is critical for physicians who may play a role in the diagnosis of melanoma to be knowledgeable of how to approach a suspicious nevus. A full thickness of tissue is necessary to microstage the melanoma and thereby guide subsequent treatment decisions. The past two decades have witnessed a dramatic change in the surgical management of this disease in that the margin of excision seems to be constantly shrinking. Well-conducted randomized studies have shown conclusively that narrower margins are sufficient for thin and intermediate thickness melanomas. Thus, the survival is comparable with that achieved for more radical excisions with less functional and cosmetic deficit.