What is the recommended surgical management for localized melanoma?

What is the recommended surgical management for localized melanoma?

• A. Punch biopsy without nodes.
• B. Laser ablation.
• C. Complete wide excision with lymph node biopsy or dissection.
• D. Mohs micrographic surgery.

Answer: (C)

Localized melanoma is best treated by removing the tumor with adequate margins and evaluating the regional lymph nodes. The aim is complete excision of the lesion to prevent local recurrence, with the margin width guided by tumor thickness, while simultaneously assessing nodal involvement to stage the disease and guide further management. This is typically done with a complete wide local excision of the primary lesion and a biopsy of the regional lymph nodes (often a sentinel lymph node biopsy; if nodes are positive, therapeutic lymph node dissection may follow). Punch biopsy without addressing margins or nodes only provides a diagnosis and does not remove the tumor with proper margins or assess nodal disease. Laser ablation removes tissue without reliable margins or histologic assessment, making it inadequate for definitive melanoma treatment. Mohs surgery, while useful for certain skin cancers, is not the standard approach for most localized melanomas because it does not consistently provide the required margin control and nodal assessment needed for melanoma management.

Localized melanoma is best treated by removing the tumor with adequate margins and evaluating the regional lymph nodes. The aim is complete excision of the lesion to prevent local recurrence, with the margin width guided by tumor thickness, while simultaneously assessing nodal involvement to stage the disease and guide further management. This is typically done with a complete wide local excision of the primary lesion and a biopsy of the regional lymph nodes (often a sentinel lymph node biopsy; if nodes are positive, therapeutic lymph node dissection may follow).

Punch biopsy without addressing margins or nodes only provides a diagnosis and does not remove the tumor with proper margins or assess nodal disease. Laser ablation removes tissue without reliable margins or histologic assessment, making it inadequate for definitive melanoma treatment. Mohs surgery, while useful for certain skin cancers, is not the standard approach for most localized melanomas because it does not consistently provide the required margin control and nodal assessment needed for melanoma management.