Surgery is the primary therapeutic modality in the treatment of primary melanomas and metastases to lymph nodes. Surgery also plays an important role in the therapy of locally recurrent tumors and distant metastases in selected cases. Wide excision of the primary tumor in stage I malignant melanoma results in a recurrence rate of about 2%. Surgical techniques for lymph node dissection are the same for melanoma as those performed for other malignancies. There is little question that dissection is necessary in obviously involved nodal areas, but controversy remains regarding the value of lymph node dissection of clinically uninvolved regional nodes. A prospective, randomized study by the World Health Organization has shown no improvement in survival for patients who underwent elective regional node dissection. Surgery is the treatment of choice when melanoma recurs locally as a single cutaneous or subcutaneous nodule. Surgery may also result in long-term, disease-free survival in patients with a solitary distant metastasis after treatment of a primary lesion.
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