Evidence-based treatment of early-stage melanoma

The vast majority of patients with newly diagnosed melanoma are "early-stage" - ie, clinically localized to the primary cutaneous site. For such patients, surgery represents the mainstay of treatment; current standards of surgical management have evolved based on evidence obtained from randomized trials, large multi-center and single institutional databases, and consensus panels. Treatment strategies include wide excision of the primary site with margins dictated by important biological features such as Breslow tumor thickness, and sentinel node biopsy to surgically evaluate the regional nodal basins at risk. Sentinel node biopsy has become an important component of the initial management of many of these patients for accurate staging of regional lymph nodes, as well as enhanced regional disease control and improved survival in the patients with microscopically involved nodes. Evidence is presented that supports the rational use of these surgical strategies and reconciles some of the controversies that have emerged. The degree to which established national treatment guidelines are followed and the consequences of non-compliance with these guidelines have become the focus of recent clinical investigations; results of these efforts are also discussed.