Wide local excision (WLE) with sentinel lymph node biopsy (SLNB) remains the cornerstone for treatment of patients with intermediate-thickness and thick melanoma lesions with clinically negative nodes. This procedure involves resection of the melanoma with circumferential margins including all the subcutaneous tissue to the level of the deep fascia. WLE is accompanied by lymphatic mapping in order to localize, resect, and analyze the sentinel node(s) for the presence of lymph node metastases. In this paper with accompanying animation and video, a 40-year-old otherwise healthy patient presents with a new melanoma on his back diagnosed via biopsy. The surgical management of intermediate-thickness melanoma and rationale for treatment are reviewed. We also highlight recent advances in postoperative treatment of those with clinically occult regional disease.