The surgical therapy of malignant melanomas.

Survival from malignant melanoma has been serially followed over a long period of time. A summation of this information is seen in Table 5. The steadily improving 5- and 10-yr disease-free intervals in stage I disease probably represents a combination of increased awareness of early lesions and the application of aggressive, initial surgical treatment. The ominous and essentially unchanged prognosis in stage II disease reinforces this goal. Suspicion and gross recognition of early melanoma is essential. Adequate biopsy with the appropriate classification provides the surgeon with insight into the correct therapy. This usually entails wide, three-dimensional excision and wound closure by free skin-grafting. Regional lymphadenectomy is performed whenever anatomical and microscopic conditions dictate the need. The roles of amputation, regional perfusion, and adjuvant therapy require clarification. Studies are being pursued to provide firm data concerning the value of these methods.