Fundamentals of Melanoma

For plastic surgeons managing melanoma, randomized data are available to support margins based on tumor thickness. Sentinel lymph node (SLN) status is the strongest prognostic factor for disease-free survival. Nomograms help individualize a patient’s risk of positive nodal disease. Staging relies on accurate pathologic tumor and nodal assessment. Ultrasound surveillance for a positive sentinel node biopsy is supported by randomized trials. The keystone flap is a reliable reconstructive method to avoid skin grafts for extremity defects. In-transit recurrence can be effectively controlled through minimally invasive modalities. Rapid advances in neoadjuvant, adjuvant, and metastatic systemic therapies are revolutionizing multidisciplinary care of patients with melanoma.