SURGICAL-TREATMENT OF MALIGNANT-MELANOMA

The surgical treatment of the primary melanoma site has been made more rational through correlations of rates of local control with various margins of resection in the context of the dominant prognostic indicat or for localized melanoma, the thickness of the primary lesion. It is now known that for lesions less than 1 mm in thickness, a l-cm margin is satisfactory. For lesions 1 to 4 mm thick, a 2-cm margin is adequat e according to the results of a multi-institutional, randomized, surgi cal trial. Lesions thicker than 4 mm should be treated with a margin l arger than 2 cm where the anatomy permits, although the main concern f or these lesions is their high propensity for distant dissemination. E lective dissection has not been shown to alter survival significantly in prospective randomized trials. Surgical treatment of distant metast ases is indicated for the palliation of a symptomatic lesion, for exam ple, solitary brain metastasis or gastrointestinal metastases.