What is the primary treatment modality for malignant melanoma?

Surgical excision with appropriate margins is considered the primary treatment modality for malignant melanoma because it directly removes the tumor and any surrounding tissue that may harbor cancerous cells. Complete surgical excision is crucial, especially in early-stage melanomas, as it not only helps to eliminate the cancer but also provides important pathological information regarding tumor thickness and subtype, which can influence further treatment decisions.

Surgical intervention remains the cornerstone of treatment because melanoma is highly linked to local recurrence and metastasis; thus, achieving negative margins is essential to reduce the risk of recurrence. If the melanoma is detected at an early stage, often surgical excision alone may suffice for treatment.

In more advanced cases where the disease has metastasized, additional treatment options such as immunotherapy or targeted therapies become important but are considered adjuncts rather than the primary approach. While immunotherapy (e.g., pembrolizumab) and targeted therapies (e.g., trametinib) significantly improve outcomes for certain patients with advanced disease or specific genetic mutations, they are not the first-line treatment for localized melanoma. Instead, they are used after surgical excision when the cancer has progressed or spread. Similarly, chemotherapy, although an option in certain settings, is not the mainstay for melanoma treatment due to