The primary treatment of a
melanoma is surgical excision. An excisional biopsy is preferred, and safety margins of 1 cm for
tumor thickness up to 2 mm and 2 cm for higher
tumor thickness should be applied either at primary excision or in a two-step procedure. When dealing with facial, acral or anogenital
melanomas, micrographic control of the
surgical margins may be preferable to allow reduced safety margins and conservation of tissue. The sentinel lymph node biopsy should be performed in patients whose primary
melanoma is thicker than 1.0 mm and this operation should be performed in centers where both the operative and nuclear medicine teams are experienced. In clinically identified
lymph node metastases, radical
lymph node dissection is considered standard
therapy. If distant
metastases involve just one internal organ and operative removal is feasible, then surgery should be seen as
therapy of choice.
Radiation therapy for the primary treatment of
melanoma is indicated only in those cases in which surgery is impossible or not reasonable. In regional lymph nodes,
radiation therapy is usually recommended when excision is not complete (R1 resection) or if the nodes are inoperable. In distant
metastases,
radiation therapy is particularly indicated in bone
metastases,
brain metastases and soft tissue
metastases.