Controversy in the surgical management of melanoma

In more than one half of cases of melanoma the disease is not controlled. Treatment of the disease should be based on a clear understanding of its biology and natural history. This paper presents an overview of the controversial issues in the management of primary melanoma and suggests an acceptable approach. The author recommends: (a) excisional biopsy where anatomically feasible for adequate histologic assessment, (b) wide excision of the tumour including the deep fascia, (c) en bloc in-continuity dissection for lesions close to the regional lymph nodes and (d) selective elective lymphadenectomy for clinical stage I melanoma and other groups, based on Clark's level of invasion and Breslow's thickness of the lesion, its location, histologic factors and the patient's medical and socioeconomic background.