The indications for a regional node dissection and the timing of such operation following the diagnosis of malignant melanoma are still the subject of valid debate. During the past 2 decades there has been a gradual shift in the treatment of all malignant disease from an adequate local operation to more extensive operative procedures. In recent years, questioning voices have been heard expressing doubt as to the necessity of such additional surgery, particularly with regard to malignant melanoma. This review was undertaken to attempt to ascertain the validity of advising a more extensive operation than local treatment in the primary management of malignant melanoma. The patients included in this review seem particularly appropriate to this type of study, because during this period of almost 20 years, varying methods of management have been advised. Originally, only local excision and, when necessary, therapeutic regional node dissections were performed. More recently, excision and