Melanoma Treatment - Surgery

Surgery is the mainstay of therapy for early-stage melanoma and for the removal, or resection, of a diagnosed melanoma. Skin biopsy techniques and sentinel lymph node biopsies are first-line surgical procedures used in diagnosing melanoma; once diagnosed, many other types of surgery are employed when appropriate.

Types of Surgery

The initial biopsy may be performed by a dermatologist or dermatologic surgeon. Surgery to remove melanoma may be performed by a surgical oncologist, a plastic surgeon, a head-and-neck surgeon or by a combination of these specialists, using the following techniques:

  • 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 decrease the chance 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: a radioactive tracer and dye are injected into the site of the primary melanoma to “drain” the lymph node basin. They are then examined under a microscope to determine if there are any melanoma cells detected.

Lymph Node Status

Lymph nodes are small glands that work as filters throughout your body. They contain immune cells that help fight infection and destroy germs carried in lymph fluid. There are hundreds of lymph nodes throughout your body and they are located primarily in the neck, armpits and groin. 

If the original, or primary, melanoma has certain high-risk characteristics, your doctor may want to examine your lymph nodes. This will help your doctor determine whether melanoma cells have traveled beyond the original site of the lesion. To check this, your doctor will perform a sentinel lymph node biopsy. The sentinel node is the first lymph node to which cancer is most likely to spread. If melanoma is found, the surgeon may remove additional lymph nodes to check for melanoma. 

The extent of lymph node involvement, as well as other factors, will help your doctor determine your stage of diagnosis. It is very important to find out your stage as this information will help drive your treatment plan. If no melanoma is found in the lymph nodes, then it is likely that no additional surgery will be performed. 

If you are newly diagnosed, it is important that you learn about all available treatment options