Surgery

Surgery is the treatment of choice for patients with localized melanoma. Current guidelines recommend margins of resection as follows:

Sentinel lymph node biopsy should be considered in patients with thin lesions (≤1 mm) and ulceration, mitotic rate greater than 1/mm2, young age, and lesions larger than 1 mm with or without adverse features. Younger patients have a higher incidence of sentinel lymph node positivity, and this feature may adversely affect clinical outcomes.[3,4]

If the sentinel lymph node is positive, the option to undergo a complete lymph node dissection should be discussed. One adult trial included 1,934 patients with a positive sentinel node, identified by either immunohistochemistry or polymerase chain reaction. The patients were randomly assigned to undergo either complete lymph node dissection or observation. The 3-year melanoma-specific survival rate was similar in both groups (86%), whereas the disease-free survival (DFS) rate was slightly higher in the dissection group (68% vs. 63%; P = .05). This advantage in DFS was related to a decrease in the rate of nodal recurrences because there was no difference in the distant metastases–free survival rates. It remains unknown how these results will affect the future surgical management of children and adolescents with melanoma.[5]