Melanoma Treatment: Stepwise Approach from Biopsy to Adjuvant Therapy

Standard Workup

1. Clinical exam + dermoscopy.
2. Excisional biopsy with narrow margins for diagnosis and Breslow depth.
3. Staging imaging (CT, MRI, PET/CT) for T3/T4 or nodal symptoms.
4. Sentinel lymph node biopsy (SLNB) for T1b–T4a (≥0.8 mm or ulcerated).

Treatment by Stage

• Stage 0–II: Wide local excision (margins per Breslow); SLNB as indicated.
• Stage III (nodal): Completion lymphadenectomy (now selective) + adjuvant therapy (PD‑1 inhibitor, BRAF/MEK if mutated, or clinical trial).
• Stage IV: Systemic therapy: immunotherapy (anti‑PD‑1), targeted therapy (BRAF/MEK inhibitors), T‑VEC, clinical trials.

Follow‑Up

Skin/node exams every 3–12 months per NCCN; imaging for stage IIB–IV. Early detection of new primaries or recurrence saves lives.