Surgical management of melanoma

Historically, the surgical management for melanoma was ossified for nearly 50 years with the standard of care being wide local excisions with 5-cm margins. Several clinical studies have now brought to light new data that have enabled academic groups such as the American Joint Committee on Cancer and the National Comprehensive Cancer Network to update surgical guidelines reliant on evidence with long-term follow-up. In addition, basic research at the bench has dispelled the myth that all melanomas are genetically identical and behave in a homogeneous way on the basis of the Breslow depth of the original tumor. It is now known that although all melanomas arise from the melanocyte, melanoma encompasses a variety of cancers that are genetically distinct with variable predicted outcomes often associated with the anatomic location of the tumor. This article cites the evidence on which the current surgical guidelines are based and it addresses some of the ongoing controversies regarding the surgical management of the various types of melanoma.