Key points localised disease

• The incidence of cutaneous malignant melanoma continues to rise worldwide but there is evidence of a levelling of mortality in some groups as patients are presenting earlier.

• Incisional biopsy of a melanoma does not in general alter the prognosis adversely but may lead to problems in interpreting the histology.

• The main treatment for primary melanoma of the skin is surgical excision.

• There is good evidence from RCTs that the narrower margins used over the past 20 years are safe.

• All the treatments used for LM and LMM have poor evidence to support them and well-organised RCTs are needed in this area. Surgical excision probably represents the best treatment on current evidence.

• Elective lymph node dissection of uninvolved nodes does not improve prognosis in most patient groups.

• SLNB is a useful staging tool but there is no evidence as yet that it improves overall survival.

• Interferons used as adjuvant treatments can benefit some patient groups with MM, but further information is needed to clarify the optimum usage of this treatment.

analysis of the high-dose regimen, the estimated 11. cost per life-year gained was US$13 700 over 35 years and US$32 600 over 10 years; the estimated cost of low-dose treatment per life- 12. year gained was estimated to be US$1700 over a lifetime and US$6600 over 10 years. These costs were thought to be comparable to many 13. other oncological treatments.51,52

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