Regional Lymph Node Dissection and Malignant Melanoma

The biological behavior of malignant melanoma is so ubiquitous that the outcome, in any given instance, may bear no predictable relationship to the choice of therapy. This paradox is especially evident when one considers that the primary lesion, when on the skin, is ordinarily readily accessible to inspection and palpation and, therefore, should lend itself to effective eradication at an early stage. Until such time as our knowledge of cellular chemistry permits a chemotherapeutic attack on the disease, the surgeon is obliged to pursue a vigorous course of extirpative therapy that can accomplish no more than physical separation of the disease from the host, in one "region" of the body. While there is uniform agreement that wide regional excision of melanoma is the basis of primary treatment, there is a considerable divergence of opinion on two points. 1) How "wide" is wide surgical excision, and 2) what is the role