Decision in the management of cutaneous malignant melanoma

Eighty-five percent of the cases of cutaneous malignant melanoma can be identified during a biological stage in which they are incapable of producing metastases and can be cured by surgical excision, alone. Recognition of these cases has major impact for potentially improving survival in this neoplastic system. Once recognized, excisional biopsy of the primary melanoma enables the pathologist to accurately microstage these tumors. The role of surgery, both for the primary site and the regional lymph nodes, continues to undergo refinement as additional information regarding the biology of melanoma becomes available. Adjuvant chemotherapy and/or immunotherapy remains investigational, at present, and awaits the demonstration of its clinical value.