Progress in the surgical treatment of early-stage malignant melanoma

Surgical treatment of early-stage malignant melanoma has shifted from traditional wide margins to precise, individualized approaches. This article systematically reviews the standards for surgical margin width and their impact on locoregional recurrence and survival outcomes, emphasizing how tumor thickness and anatomical location guide margin design. Sentinel lymph node biopsy, an important staging and prognostic tool, has greatly improved detection accuracy and safety through technological innovation and multimodal imaging, gradually replacing traditional lymphadenectomy and supporting more evidence-based treatment decisions. Mohs micrographic surgery, a minimally invasive, precise-margin technique, has shown significant advantages in functionally sensitive areas and specific tumor subtypes, achieving real-time comprehensive pathological assessment of margins and maximizing functional preservation, thereby reducing locoregional recurrence rates. Advances in systemic therapies, particularly immunotherapy and targeted therapy, are profoundly reshaping the timing and scope of surgeries through models such as neoadjuvant therapy, promoting a “response–adaptive” surgical approach. Individualized surgical strategies based on patient age, tumor thickness, molecular characteristics, and tumor location differences allow rational adjustment of surgical margins and adjuvant treatment planning, while integration with neoadjuvant and adjuvant systemic therapies may reduce operative extent, postoperative complications, and impairment in quality of life. Multidisciplinary cooperation and the integration of telemedicine technology also play key roles in surgical decision-making and follow-up. Looking ahead, the surgical treatment of early-stage malignant melanoma will further integrate molecular biology and advanced imaging technologies for precise staging and precise surgery, transform unresectable lesions through neoadjuvant therapy, and establish new models of minimally invasive and individualized treatment, ultimately improving patient survival rates and quality of life.