The changing controversy over surgical resection margins for stage I cutaneous melanoma

Over the last century, the recommended margins of surgical resection for cutaneous malignant melanoma have decreased. There is a danger in misinterpreting histopathologic findings such as atypical melanocytes and microscopic satellites as the basis for choosing wide surgical excision. The efficacy of wide surgical excision for malignant melanoma remains to be proven. When tumor thickness is disregarded, metastasis and overall survival seem unaffected by the width of surgical margins. The surgical treatment of malignant melanoma should be complete excision of the neoplasm. If the margins are clear histopathologically, no further local surgery is needed. Wide surgical resection of the primary lesion will have no effect on distant metastases. Once clear markers of melanoma dissemination have been identified, based either on thickness or on other histopathologic or immunologic variables, an adequate resection margin can be formulated. A thorough understanding of exactly which variables portend "cryptic" dissemination and influence prognosis will lead to better management of cutaneous malignant melanoma.