Management of melanoma includes wide excision with adequate margins and lymph node biopsy depending on the depth of the lesion, with subsequent completion lymphadenectomy for positive sentinel node. Locally advanced disease can be approached in several different ways depending on a variety of patient and disease-specific factors. These include surgical resection, isolated limb perfusion and infusion and intralesional injection therapy such as talimogene laherparepvec, IL-2 and Bacille Calmette-Guerin. Ongoing controversy exists regarding the utility of completion lymphadenectomy, and trials such as MSLT-2 will attempt to shed light on this issue. The future of melanoma management will likely focus on expanding the use of immunotherapy, allowing for narrower surgical margins, particularly in sensitive anatomic areas, and limiting the number of completion lymphadenectomies.
Keywords: T-VEC; completion lymphadenectomy; in-transit disease; intralesional injection therapy; isolated limb infusion; isolated limb perfusion; melanoma; melanoma in situ; melanoma margins; sentinel lymph node biopsy.