Advances in surgical treatment of melanoma

Malignant melanoma is fatal in one-fifth of the patients who are diagnosed with the disease. It is a solid tumor cancer that spreads primarily through lymph nodes, making it amenable to surgical treatment. Surgical interventions for melanoma that have developed over the years include diagnostic biopsy, wide excision, lymph node staging, and treatment of local and visceral metastases. Lymphatic mapping and sentinel lymph node biopsy are two important surgical approaches that are gaining favor over more traditional nodal staging. The use of reverse transcriptase-polymerase chain reaction (RT-PCR) to diagnose submicroscopic disease shows promise for staging patients at the earliest possible time. Multicenter, randomized clinical trials such as the Sunbelt Melanoma Trial are vital in answering the question of how best to treat early metastatic melanoma.