Surgical management of primary cutaneous melanoma: excision margins and the role of sentinel lymph node examination.

Surgical strategies for managing patients who have primary cutaneous melanoma have changed dramatically over the past 30 years. More conservative excision margins have been shown to be adequate, and routine complete lymph node dissection (CLND)has been abandoned since the sentinel node (SN) biopsy technique was introduced. Knowledge of a patient's SN status not only provides a reliable guide to prognosis, but also allows CLND to be avoided in 80% to 85% of patients. Recent clinical trial results suggest that SN biopsy, with immediate CLND if an SN is positive,confers a survival advantage in those who have metastatic disease in regional nodes. Minimally invasive and noninvasive methods of SN assessment, such as magnetic resonance spectroscopy, are being evaluated.