Management of precursors and primary lesions of melanoma

A better understanding of the natural history of pigmented lesions has recently led to a more conservative surgical approach to the management of certain congenital, dysplastic, and other acquired melanocytic nevi. The treatment of primary melanoma is still based almost exclusively on the thickness of the primary lesion. Recent data showed that a surgical margin of 1 cm is appropriate treatment of most thin melanomas (1 mm or less in Breslow thickness), whereas thicker lesions may be removed with a surgical margin of 2 to 3 cm without adversely affecting the rate of local recurrence or patient survival. These recommendations are guidelines only and may be modified by the anatomic site and histologic subtype of tumor. The value of prophylactic lymph node dissection in the management of primary melanoma is still debated and awaits the results of randomized, prospective studies.