Surgical management of melanoma

The incidence of melanoma is rising more rapidly than any other malignancy. More conservative margins of excision have been established and the role of elective node dissection awaits determination by prospective randomized trials. Lymphoscintigraphy has clarified lymphatic drainage from watershed areas. Lymphatic mapping and sentinel node biopsy may lead to acceptance of selective lymphadenectomy, and also allows for more sensitive staging. Further advances in outcome require the development of effective systemic adjuvant therapies. Until such time, surgery continues to play a pivotal role in all stages.