Current Therapy of Cutaneous Melanoma

Learning Objectives: After studying this article, the participant should be able to: 1. Cite histopathologic and patientrelated risk factors associated with an increased risk of melanoma recurrence. 2. Describe the appropriate margin(s) of surgical excision for primary cutaneous melanoma. 3. Discuss the controversies and review current options for management of regional lymph nodes. 4. Describe the current status of adjuvant therapy for melanoma. Melanoma is a growing public health problem. Optimal care of the melanoma patient is multidisciplinary, but plastic surgeons and other surgical specialties play a central role in the management of these patients. Although surgery remains the mainstay of therapy for melanoma, several recent clinical studies have helped to clarify the biology of the disease and have changed the patterns of care for patients with melanoma. The advent of lymphatic mapping for interrogation of regional lymph nodes and interferon as the first effective postsurgical adjuvant therapy have had a major impact on the care of melanoma in the United States and elsewhere. This article will review the current clinical approach and therapy for cutaneous melanoma. The diagnosis, prognostic variables, staging evaluation, current surgical and medical treatment, and follow-up guidelines for patients with all stages of melanoma are reviewed. Recent studies, controversies, and directions of future investigational therapies will be discussed. (Plast. Reconstr. Surg. 105: 1774, 2000.)