Surgical treatment of primary melanoma

The incidence of primary cutaneous malignant melanoma (MM) has been rapidly growing during the last decades with only a small rise in overall mortality. MM accounts for most of the deaths from skin malignancies due to its metastatic potential. However, early detection and wide surgical excision with histologically negative margins are nearly always curative for patients without micrometastatic disease. Although nonsurgical treatments have been increasingly used in recent years, surgery with standardized margins remains the only curative treatment modality for primary cutaneous MM. There are some special locations (e.g., the ear, nose, eyelid, genitalia, hand, or foot) where standardized wide surgery can not be completely achieved either for lack of tissue, ill-defined lesions, or cosmetic and functional reasons. Thus, skin surgeons dealing with these MMs should be well versed in new technologies such as confocal microscopy for the presurgical assessment of ill-defined lesions or the promising electrochemotherapy for nonsurgical tumors. Furthermore, a multidisciplinary melanoma team and a well-trained and experienced surgeon are mandatory to deal with these "out-of-the-guidelines" melanomas.