The European Society for Medical Oncology (ESMO) held a consensus conference on melanoma on 5–7 September 2019 in Amsterdam, The Netherlands. The conference included a multidisciplinary panel of 32 leading experts in the management of melanoma. The aim of the conference was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where available evidence is either limited or conflicting. The main topics identified for discussion were: (i) the management of locoregional disease; (ii) targeted versus immunotherapies in the adjuvant setting; (iii) targeted versus immunotherapies for the first-line treatment of metastatic melanoma; (iv) when to stop immunotherapy or targeted therapy in the metastatic setting; and (v) systemic versus local treatment of brain metastases. The expert panel was divided into five working groups in order to each address questions relating to one of the five topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the results relating to the management of locoregional melanoma, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript. •A melanoma consensus conference, organised by the ESMO Guidelines Committee, was attended by 32 experts from 14 countries•The experts compiled recommendations (with supporting evidence) on controversial topics in melanoma management•Recommendations for locoregional melanoma in this manuscript include:○indications for sentinel lymph node biopsy and radical lymph node dissection○adjuvant targeted versus immunotherapy○adjuvant therapy in specific situations (after node dissection, stage IIIA, resected stage IV, in-transit metastasis)○adjuvant therapy toxicity management•A separate manuscript presenting results relating to the management of metastaticmelanoma is also available