Specialized medical centers perform high-resolution ultrasound of lymph nodes in melanoma patients to detect metastases early. Ultrasound represents a highly effective method for the discrimination of lymph node and soft-tissue metastases from other space-occupying lesions. Frequent follow-up examinations with ultrasound provide early detection of tumor recurrences and seem to lead to a prolonged overall survival. The ultrasound findings are validated by fine-needle aspiration cytology. Depicted and verified metastases should be removed as soon as possible. The authors recommend the performance of ultrasound before every sentinel lymph node dissection to avoid unnecessary operations.