The surgical treatment of malignant melanoma is dependent on early diagnosis and a thorough understanding of the options available to patients who present with more deeply invasive lesions. There has been a shift in therapy of primary skin lesions to using narrower (1-2 cm) margins of excision. Decisions regarding treatment of the regional lymph nodes are predicated upon understanding the overall risk of metastatic spread and delineating the pattern spread of the malignant cells. The concept of intraoperative lymphatic mapping can greatly aid the clinician in deciding (1) which lymph node group is the primary drainage basin for any particular area of skin, and (2) which lymph node is the first node to receive lymphatic drainage from any given area (the so-called 'sentinel lymph node.'). Surgical resection of metastases can result in prolongation of survival in carefully selected patients.
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