Minimizing morbidity in melanoma surgery.

The selection of a treatment modality involves a balance between risk and benefit. Surgical decision making is intrinsically dependent on potential morbidity; therefore, the desire to minimize adverse outcomes remains paramount in the effort to provide patients with the widest range of therapeutic options. The adoption of sentinel lymph node biopsy for the evaluation of regionally metastatic melanoma has reduced the number of complete lymphadenectomies and their attendant comorbidities. For patients who require completion lymphadenectomy, selective lymphadenectomy and, more recently, videoscopic inguinal lymphadenectomy have been shown to further reduce wound-related complications, while maintaining equivalent regional control and lymph node yield, respectively. Finally, in carefully selected patients laparoscopic metastasectomy can increase survival with less impact on quality of life than open extirpation. Ongoing trials, such as the Multicenter Selective Lymphadenectomy Trial II (MSLT-II), and research into gene profiling may improve the selection of patients for surgery. Obviating the need for surgery may offer the greatest reduction in morbidity of all.