Managing Malignant Melanoma

Learning Objectives: After reading this article, the participant should be able to: 1. Discuss the diagnosis, pathologic characteristics, and staging of cutaneous malignant melanoma. 2. Identify the indications for a sentinel lymph node biopsy. 3. Develop an operative plan including resection margins for melanoma and stages in performing a sentinel lymph node biopsy. 4. Recognize the signs of metastatic melanoma and discuss surgical and nonsurgical management options. Summary: The incidence of melanoma is increasing worldwide. Melanomas represent 3 percent of all skin cancers but 65 percent of skin cancer deaths. Melanoma is now the fifth most common cancer diagnosed in the United States. Excisional biopsy should be performed for lesions suspicious for melanoma. The pathologist's report provides essential information for surgical treatment; the most important information is the Breslow depth of the lesion. In addition to wide surgical excision of the primary lesion, sentinel lymph node biopsy is the standard of care for early identification of regional metastasis. Nodal metastasis found in the sentinel lymph node biopsy should be followed with a complete lymph node dissection. Although surgery remains the primary treatment of melanoma, recent advances in chemotherapy may offer further survival benefits to patients with metastatic disease.