Clinical management of melanoma requires insight into the utility of adjuvant surgical and systemic therapy options. This article discusses the evidence from randomized, controlled trials of adjuvant surgical therapy, sentinel node biopsy, and surveillance of regional lymph node basins by ultrasound. Ultrasound also can be used to identify metastasis in the sentinel node to avoid unnecessary sentinel node biopsies. It describes the experience with chemotherapy, immunostimulants, and vaccines, which have failed as adjuvants in stage II-III disease. Interferon has a consistent effect on relapse-free survival, although it does not have a significant benefit for overall survival.