Three unresolved issues in the surgical treatment of melanoma.

The authors discuss the results of recent clinical trials on what constitutes an adequate resection margin in primary melanomas of varying thickness, concluding that it is still uncertain whether wider margins reduce the risk of regional cutaneous recurrences. Inherent in the issue of whether or not to perform elective node dissection is the difficulty of identifying patients who might benefit from the procedure. Proponents point to two recent studies, but actually the sample sizes were small. Isolated limb perfusion, while producing complete responses with long-term survival in some cases of regionally recurrent disease, is still questionable as a prophylactic treatment for high-risk primary disease.