Surgical management of malignant melanoma.

Wide and mutilating surgical excision is contraindicated for primary malignant melanoma. Tumours less than 1 mm thick require only 1 cm excision margins while those 1-4 mm thick need only 2 cm margins. Primary closure without skin grafting should always be attempted. Axillary and inguinal block dissection remain standard treatment for established lymphatic metastases but elective block dissection is still controversial and should only be performed in the context of a clinical trial. Selective lymphadenectomy based on intraoperative lymphatic mapping is being evaluated. Isolated limb perfusion plays an important role in palliation, and perfusion with a combination of cytotoxic agents and cytokines is an exciting therapeutic advance. Laser vapourization under local or general anaesthesia is an alternative way of treating multiple small cutaneous and subcutaneous lesions and is much better tolerated.