Operative Techniques for Melanoma

This chapter will focus on the various operative techniques for biopsy and excision of cutaneous melanoma as well as the assessment and dissection of regional lymph node basins. The technique of performing a shave, punch, and incisional biopsy is reviewed, along with the advantages and disadvantages of each approach. This is followed by a discussion about standard recommendations regarding margins for wide excision and how to approach a wide excision of a melanoma in difficult areas like the nail beds, digits, and the heel. Common reconstructive techniques for tissue defects such as local tissue advancement and rhomboid flaps, as well as VY flaps, are described. Finally, complete lymph node dissection techniques are described in detail for the axillary, inguinal, and cervical lymph node basins.