Melanoma Treatment - Surgery

Surgery is the mainstay of therapy for early stage melanoma and for resection of an isolated metastatic melanoma site. Skin biopsy techniques and sentinel lymph node biopsy have been discussed, in general terms, previously and are the most common types of surgery used in melanoma; however, many other types of surgery are employed when appropriate.

Surgery Medical Oncology Team

The initial biopsy may be performed by a dermatologist or a dermatologic surgeon. Surgery may be performed by a surgical oncologist, a plastic surgeon, a head and neck surgeon, or a combination of these specialists. 

Types of Surgery

• Simple Excision:  thin melanomas are removed along with a small amount of non-cancerous skin at the edges.
• Mohs Surgery:  a small section of apparently normal skin beyond the visible melanoma is removed and looked at under a microscope.  If abnormal cells are identified another small section is removed and this process continues until the cells removed no longer look abnormal.
• Wide Local Excision:  this excision is used to decease the change of local recurrence.  A wide excision, usually 1-2 cm, is made around the original melanoma site and the tissue is sent to the pathologist for evaluation.
•  Sentinel Lymph Node Biopsy:  during a sentinel lymph node biopsy, a radioactive tracer and a dye are injected into the site of the primary melanoma. These agents are then traced to the “draining” lymph node basin. A small incision is made into the area where these two agents traveled and the lymph nodes involved are removed. They are then examined under a microscope to determine if there are any melanoma cells detected. In no melanoma cells are found, then no further surgical intervention is performed. If this lymph node does contain melanoma cells, then a second surgery to remove additional lymph nodes will be performed. These additional lymph nodes are also evaluated by a pathologist to determine if they contain any melanoma cells. This information is important in determining the stage of a person’s melanoma.  (moved from another area)