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Melanoma is the most aggressive skin cancer. Early recognition, diagnosis and beginning of the treatment are conditions of a favorable course and prognosis of this potentially fatal disease. Clinical characteristics of pigmented skin lesion with characteristic anamnesis and predisposing factors indicate with high reliability the occurrence of skin melanoma. A biopsy of suspected skin pigmented lesion is the most reliable diagnostic procedure by which decision is made on the extensiveness of surgery. A microscopic stage melanoma (Breslow classification by) has a prognostic features. Surgery is still the most effective treatment modality of skin melanoma. The margins of excision are determined by the thickness of primary tumor. The study of biological characteristics of melanoma changed the surgical attitude in terms of excision extensiveness. The concept of wide excision combined with skin graft covering of skin defect, by much more rational excision margins and defect closure with skin flap, with no effect on recurrence, tumor dissemination and patients survival. The radicality of excision is determined by the thickness of the primary tumor. All available plastic surgery method can be applied in closing the defect without affecting the course of the disease, given the functional, aesthetic and economic criteria. The sufficiency of the available reconstructive procedures makes plastic surgery irreplaceable in the surgical treatment of the primary melanoma of the skin.

Surgical access to the treatment of primary skin melanoma