Staging and surgical treatment of skin melanoma: current status of the problem

The review examines the current state of two closely related areas of management of patients with skin melanoma – clinical staging and surgical treatment. Against the backdrop of a global increase in melanoma incidence and a significant contribution of skin neoplasms to the structure of oncological pathology in the Russian Federation, approaches to staging and surgery have undergone a fundamental transformation [1–6]. A brief historical evolution of approaches is presented, from the «wide excision» paradigm of Handley and the concepts of Breslow and Clark, to the introduction of sentinel lymph node biopsy by Morton and the era of neoadjuvant immunotherapy [7–9]. The current AJCC 8th edition staging system is thoroughly analyzed, which remains clinically effective for skin melanoma; changes to the AJCC 9th edition classification are announced [10–12]. The principles of the pathomorphological protocol (Breslow, ulceration, mitotic index, satellites, lymphovascular invasion), imaging, and molecular diagnostics (BRAF/NRAS/NF1/KIT, ctDNA, GEP) are analyzed [13–19]. Modern surgical margins are discussed, with a focus on the 2025 meta-analysis (1 cm vs 2 cm) and the ongoing MelMarT-II study [20–22]. Approaches to BSLU after MSLT-II and DeCOG-SLT, the abandonment of routine complete lymphadenectomy, and changes in surgical approaches after the NADINA, SWOG S1801, and PRADO studies for stage III are discussed in detail [23–30]. The review concludes with a section on the specifics of Russian practice and the prospects for using ctDNA as a marker of MRD, individualizing surgical volume, and non-invasive staging methods.