We examined trends in the treatment and survival in a population-based sample of white patients diagnosed with local-stage and regional-stage cutaneous melanoma in 1995, 1996, or 2001, treated in communities across the USA with vital status follow-up through 2007. White patients, aged 20 years or older with invasive cutaneous melanoma, were identified from the Surveillance, Epidemiology and End-Results population-based registries. Hospital and pathology records were reabstracted and physicians were asked to verify the provided therapy. The percentage of patients receiving lymph node biopsies increased over time. Sentinel lymph node biopsy increased between 1995 and 2001 from 5 to 32% for men and from 9 to 35% for women. The use of chemotherapy, hormonal therapy, and immunotherapy changed little. Facilities with approved residency training programs were more likely to perform lymph node dissections, to perform sentinel lymph node biopsy, and to treat patients more aggressively than were facilities without such programs. Men were significantly more likely than women to die of cutaneous melanoma. In multivariable survival analysis, after adjusting for age, Charlson score, and surgical margins, survival did not change significantly over this time. Deaths were associated with increasing tumor thickness for men and women. Surgical treatment of local or regional melanoma became more extensive over time with fewer local excisions and more lymph node dissections, but with little change in adjuvant therapy. Survival was associated with tumor thickness. Early detection when the tumor thickness is less may decrease mortality. Future research should especially target decreasing the disparity in survival between men and women.