Changes in clinical presentation and management of malignant melanoma

Records of 147 patients with primary cutaneous malignant melanoma treated at the Lahey Clinic from 1955–1979 were reviewed. Complete clinical follow‐up data were obtained, and all pathologic material was reviewed. Proposed new risk categories based on a modification of the Clark and Breslow categorizations are outlined. The incidence of low‐risk melanoma has dramatically increased (from 23–53%) and that of high‐risk melanoma has decreased (from 34–10%) over the period of this study. Dermal punch biopsy gives accurate staging information and carries no increased risk of local recurrence, nodal metastases, or death from disease. Resection of a margin of clinically uninvolved skin measuring twice the diameter of the primary melanoma minimizes local recurrence (2.5% or less), does not adversely affect survival, and reduces the need for skin grafting. Arbitrary wide margins are not justified. Regional lymphadenectomy offers no improvement in survival in patients with low‐risk and moderate‐risk melanoma and can play only a minor role at most in improving survival for patients with high‐risk melanoma.