Background Melanoma ranks as the third most common cutaneous malignancy, but it is the most lethal if early surgical treatment is neglected. Recently, updates were made on the American Joint Committee on Cancer staging system, as well as guidelines for surgical excision. Previously, grading systems were made to measure cumulative damage (solar elastosis) and to evaluate the immune reaction against the tumor [tumor-infiltrating lymphocytes (TIL)]. Aim To apply the fore mentioned advances to a series of 146 Egyptian patients primarily treated by surgery. The histochemical stains used for solar elastosis included Verhoeff stain and Alcian blue stain, pH 2.5. For phenotyping of lymphocytes and natural killer cells, the following immune markers were used: CD3, CD8, CD4, and CD56. Results Most tumors (64.4%) presented with an advanced size (>4 mm), lymph node metastases (66.7%), and inadequate excision margin (66.4%). In association analysis, only age more than 50 years, head and neck location, and the superficial spreading histologic type were significantly associated with solar elastosis. Moreover, only old age (>50 years) and large tumor thickness (>4 mm) are associated with low level of TIL, denoting poor immune reaction. Conclusion The presentation of Egyptian patients with advanced stages of melanoma calls for the implementation of public education program including self-examination of skin to detect melanoma at an early stage. Moreover, prospective follow-up studies are needed to develop guidelines of surgical excision suitable for our advanced cases. The negativity of both solar elastosis and TIL in melanoma of lower extremity supports the trauma of combined immunodeficiency and trauma in oncogenesis at this location.