Surgery remains one of the key treatment modalities for melanoma. Wide excision of the primary site with sentinel lymph node biopsy for selected patients has been recognized as the standard surgical approach for patients with early-stage disease. Controversies persist regarding margin width, indications for sentinel lymph node biopsy, and surgical management of regional nodal basins. Additionally, new therapies such as intralesional therapies as well as new systemic therapies are changing the role for surgery in patients with recurrent local–regional as well as metastatic disease. In this article, we discuss the current recommendations as well as the topics of debate in the surgical management of melanomQuestions remain about excision margins and when to perform a sentinel lymph node biopsy.