In the past, surgical treatment of cutaneous melanoma has been determined largely by assessment of the regional nodes by clinical palpation. More recently, an increasing number of reports indicate that measurement of the histologic thickness of primary melanomas and evaluation of the level of penetration of tumor cells into the dermis can predict the likelihood of development of nodal metastases. In addition performance of fine needle aspiration of questionably involved regional nodes has provided cytologic data regarding nodal metastases. The role of certain procedures, such as prophylactic (elective) node dissection remains clouded because adequate numbers of properly controlled studies have not been reported. However, increasing knowledge of important prognostic factors, cytologic findings from needle aspiration of regional nodes, as well as the clinical assessment of regional nodes, can all aid formulation of more rational management recommendations.