The core principle in the management of primary cutaneous melanoma is wide surgical excision, but occasionally a balance is needed between adequately resecting a potentially curable lesion and minimising the functional deficit in manual dexterity or ambulation for the patient. A secondary but nonetheless increasingly important consideration in this location is the potential cosmetic deformity caused by wide excision of the melanoma. Thus, the reconstructive surgeon forms an integral part of a multidisciplinary team managing patients with melanoma by providing knowledge of a wide range of reconstructive techniques, including the advantages and limitations, and a comprehensive understanding of the local and regional anatomy. The primary aim of this article is to review the current literature and available evidence on reconstruction after wide excision of primary cutaneous melanoma of the extremities.