Treatment of the primary malignant melanoma: a review

Treatment of the primary tumor in malignant melanoma includes a surgical excision of the surrounding skin and subcutaneous fat to remove tumor and occult focci. The most significant factor in predicting recurrence of melanoma at the primary tumor site is thickness of the primary tumor and the presence of ulceration. The margin of resection for lesions less than .76 mm is 1 cm and the margin of resection for lesions .76 mm or greater is 2 cm. However, we must remember that an additional margin of skin resection rarely compromises a satisfactory esthetic result and prognosis may be gravely affected by local recurrence of the tumor. The primary incisions may require special considerations if the underlying lymph nodes are also to be resected. On the face less margins may be advantageous for an optimal cosmetic result. The method of reconstruction depends upon the location and size of the defect, the functional and esthetic requirements of the patient, and the medical condition of the patient. Reconstructive methods with primary closure, split thickness skin grafts, full thickness skin grafts, local flaps, and regional flaps are discussed for different locations.