Surgical clinical trials in melanoma

The surgical treatment of melanoma has been studied in randomized prospective clinical trials that form the basis for recommendations on management of localized disease, including suggested margins for primary tumor excision and recommendations for regional nodal basin management. This article summarizes designs and results of key trials and addresses important issues in the surgical management of melanoma patients, including margins of excision of the primary tumor, elective regional lymphadenectomy, and use of prophylactic isolated limb perfusion (ILP). The ongoing Multicenter Selective Lymphadenectomy Trial and the Sunbelt Melanoma Trial, which evaluate sentinel lymph node selective lymphadenectomy, and the ILP trial sponsored by the American College of Surgeons Oncology Group are described. Data from these trials will shape the future of melanoma surgery.