ABSTRACT
Melanoma is responsible for more than 90% of deaths related to skin cancer, with rising incidence. Most cases of melanoma are diagnosed early, and therefore, surgical excision is usually the first-line treatment for achieving cure in the majority of cases. Previously, the treatment of advanced melanoma was limited. More recently, advances in systemic therapeutics, including immunotherapy and targeted therapy, have revolutionized the field of melanoma therapy. The following cases demonstrate different approaches to the management of various stages of advanced melanoma. This includes the approach to lymph node sampling and complete lymph node dissection versus nodal surveillance. The chapter also discusses the management of advanced melanoma in poor surgical candidates, including the use of imiquimod for residual malignant melanoma in situ. Cases of acral melanoma, dermal melanoma, and epidermotropic metastatic melanoma are included, demonstrating different management approaches to these rare subtypes. The chapter also reviews some common side-effects to systemic therapy and the utility of adjuvant therapy for stage III disease.
