Surgical treatment of malignant melanoma.

The surgical treatment of the primary melanoma site has been made more rational through correlations of rates of local control with various margins of resection in the context of the dominant prognostic indicator for localized melanoma, the thickness of the primary lesion. It is now known that for lesions less than 1 mm in thickness, a 1-cm margin is satisfactory. For lesions 1 to 4 mm thick, a 2-cm margin is adequate according to the results of a multi-institutional, randomized, surgical trial. Lesions thicker than 4 mm should be treated with a margin larger than 2 cm where the anatomy permits, although the main concern for these lesions is their high propensity for distant dissemination. Elective dissection has not been shown to alter survival significantly in prospective randomized trials. Surgical treatment of distant metastases is indicated for the palliation of a symptomatic lesion, for example, solitary brain metastasis or gastrointestinal metastases.