① Extended resection: Early melanoma should be treated as soon as possible after biopsy. The safe margin of extended resection is determined according to the depth of tumor infiltration in the pathological report: ① When the thickness of the lesion is ≤ 1.0mm, the safe margin is1cm; ② When the thickness is 1.0 1 ~ 2mm, the safe cutting edge is1~ 2cm; (3) thickness > 2mm, safety cutting edge is 2 cm; (4) when the thickness >; At 4mm, the latest evidence-based medical evidence supports a safety margin of 2cm.

② Sentinel lymph node biopsy (SLNB): SLNB can be considered for patients with the thickness of1mm. However, in view of the fact that the ulcer rate of skin melanoma in China is over 60% and the prognosis of skin melanoma with ulcer is poor, SLNB is recommended for patients with ulcer when biopsy technology or pathological detection technology is limited and reliable infiltration depth cannot be obtained.

③ Lymph node dissection: Preventive lymph node dissection is not recommended. In stage ⅲ patients with sentinel lymph node positive or regional lymph node metastasis (but no distant metastasis), regional lymph node dissection should be carried out on the basis of extended resection.

④ Treatment of limb migration and metastasis: Limb migration and metastasis is characterized by extensive metastasis of skin, subcutaneous tissue and soft tissue between the primary focus of a limb and regional lymph nodes, which is difficult to be removed by surgery. This type of chemotherapy mainly includes isolated hyperthermic perfusion chemotherapy (ILP) and isolated hyperthermic perfusion chemotherapy (ILI) in the world. ILI is a local treatment method of anaerobic low-flow infusion of chemotherapy drugs. The chemotherapy pathway was established by infusion of melphalan through interventional arteriovenous intubation.

⑤ If patients with stage Ⅳ have isolated metastasis, surgical resection can also be considered.

(2) Adjuvant treatment of cutaneous melanoma:

The prognosis of postoperative patients varies with different risk factors. According to the depth of lesion infiltration, ulcer, lymph node metastasis and other risk factors, postoperative patients are generally divided into four categories: ① stage ⅰ a (low risk); ② stage Ⅰ b ~ Ⅱ a (moderate risk); ③ stage Ⅱ b ~ Ⅲ a (high risk); ④ Ⅲ b ~ Ⅳ stage (extremely high risk). Low-risk patients may survive for a long time, and the 5-year survival rate is about 95%. The 5-year survival rate of medium-risk patients is about 80%, and that of high-risk and extremely high-risk patients is 10%-50%. Patients with different risks should choose different adjuvant treatments.

① Low-risk patients: At present, there is no recommended adjuvant treatment scheme, and they are more inclined to prevent the emergence of new primary lesions, focusing on observation.

② High-risk patients: High-dose interferon adjuvant therapy can prolong the recurrence-free survival, but the effect on the overall survival needs further discussion. Clinically, the choice must be made according to the patient's individual situation and treatment willingness.

③ Extremely high-risk patients: There is no standard treatment plan, but high-dose interferon α-2b is still the main treatment, which is the same as that of middle and high-risk patients.

For mucosal melanoma, adjuvant chemotherapy is recommended. For details, please refer to the item "Mucosal melanoma".

(3) adjuvant radiotherapy

It is generally believed that melanoma is insensitive to radiotherapy, but in some special cases, radiotherapy is still an important treatment. Adjuvant radiotherapy for melanoma is mainly used for lymph node dissection and postoperative adjuvant treatment of some head and neck melanoma (especially nasal cavity), which can further improve the local control rate.

(4) Systematic treatment of unresectable stage Ⅲ or metastatic melanoma.

For unresectable stage ⅲ or metastatic melanoma, it is generally recommended to give priority to medical treatment or participate in clinical trials. First of all, it is suggested that the newly diagnosed patients should undergo genetic testing, and the treatment scheme should be selected according to the results of gene mutation and the progress of the disease, including PD- 1 monoclonal antibody, CTLA-4 monoclonal antibody, BRAF V600 inhibitor, CKIT inhibitor, MEK inhibitor, high-dose IL-2 and chemotherapy. The specific treatment plan needs the clinician to choose reasonably according to the patient's situation.