gms | German Medical Science

Melanoma surgery involves the excision of primary tumors, but also its prevention as well as diagnostic or palliative procedures. Surgical removal is regarded to be the most effective treatment for potential Melanoma precursor lesions and primary malignant melanomas. Excision controls local disease and can cure the majority of patients with early tumours. Reduced safety margins of only 1 cm in cutaneous melanomas up to 2 mm thickness and of 2 cm for thicker tumours enable us to cover most defects by primary closure or simple skin flap techniques. In critical anatomical sites of acral lentiginous types and lentigo maligna melanomas microscopically controlled surgery has almost replaced wide excisions in order to preserve tissue structure and function. A matter of debate remains the precise role of sentinel node biopsy (SNB) in advanced primary tumours. Nevertheless, this technique rapidly developed over the past years as a widely accepted standard to identify more selectively patients at risk for early nodal spread, thereby avoiding the morbidity of earlier elective node dissections for the majority of patients and possibly providing a method for local disease control in the remaining cases with positive nodes. Moreover, SNB was shown to be of predictive value for risk assessment of metastases and survival particularly in patients with thicker primary tumours. However, a therapeutic worth has not yet been proven and among other aspects, the need of subsequent removal of the entire nodal basin after positive sentinel involvement remains one of the current controversies to be solved by ongoing trials.