[Surgical treatment of malignant melanoma]

Early diagnosis and total tumor excision are fundamental to assure a favorable outcome in the treatment of the malignant melanoma. Previously a large local excision up to 5 cm was recommended. In the past two decades some prospective studies showed the same survival rate when using narrower margins of excision (1-3 cm). The elective lymphadenectomy increases the survival rate only in a small group of patients and has a high rate of complications. The concept of lymphatic mapping can greatly help in finding the lymph node ("sentinel lymph node") which is the first one to receive lymphatic drainage from the affected area. This node has the highest probability of containing a metastasis and is excised. With this procedure the number of patients requiring lymphadenectomy can be limited to those who have documented lymph node metastases. The sentinel biopsy technique can provide new insight into the tumor biology of melanoma and helps in determining adjuvant therapy. In order to evaluate the influence of sentinel node biopsy on survival rate of melanoma patients clinical trials have been designed. Systemic melanoma metastases carry a poor prognosis. Surgical resection of isolated metastases may provide good palliation, in combination with other therapies.