How is melanoma treated?

The standard of care for treating melanoma is to:
1. Establish a histologic diagnosis of the suspect lesion.
2. Completely excise the tumor with adequate margins.
3. Assess for the presence of detectable metastatic disease.
4. Conduct follow-up evaluations for the rest of the patient’s life.

Pathology remains the gold standard for the diagnosis of melanoma. To establish a histologic diagnosis, the suspect lesion should be completely excised with a 1- to 3-mm margin of skin to the depth of the subcuticular fat. If this is not possible, due to anatomic location or size of the lesion, an incisional or punch biopsy to the depth of the subcuticular fat should be performed on the thickest or most atypical portion of the lesion. It is noteworthy that biopsy of lentigo maligna can be problematic, because there are often skip areas, as well as areas of regression, in these lesions that may lead to misdiagnosis. The best biopsy technique to establish the diagnosis of lentigo maligna is usually multiple punch biopsies from different sites or broad shave biopsy from multiple areas.


Once a diagnosis of melanoma is established, wide local excision of the primary tumor to the muscle fascia is recommended. It should be noted that no randomized trials have compared this approach with excision to the deep subcutaneous fat.

Aloia TA, Gershenwald JE: Management of early-stage cutaneous melanoma, Curr Probl Surg 42:455–534, 2005.

McKenna JK, Florell SR, Goldman GD, Bowen GM: Lentigo maligna/lentigo maligna melanoma: current state of diagnosis and treatment, Dermatol Surg 32:493–504, 2006.