Surgical management of melanoma

Surgery remains the mainstay of treatment of every patient in whom complete excision of all disease is feasible. For clinically localized melanoma (clinical stages 0-II), wide excision and, when appropriate, sentinel lymph node biopsy are well established. The management of stage III melanoma is more contentious. Resection remains the first choice of therapy for patients with oligometastatic melanoma in accessible locations, but careful consideration of preoperative use of highly active drugs is appropriate. Decisions regarding surgical management of stage IV melanoma should routinely be made in the context of a multidisciplinary team approach.