Melanoma

Surgical treatment

Surgery is usually the primary treatment option for melanoma and may be the only treatment necessary in certain cases, including some early-stage tumors. Surgery as initial treatment is done with the intent to cure the cancer or prolong life, and the goal of surgery is to remove all malignant tissue and reduce the risk of recurrence (reappearance) of the melanoma. Other treatments, such as targeted therapy, immunotherapy, radiation therapy or chemotherapy, may be given in addition to surgery as part of the overall treatment regimen (read more about these treaments).

In addition to removing the primary melanoma, the surgeon may remove nearby lymph nodes. A procedure known as a sentinel lymph node (SLN) biopsy may be performed to find out if melanoma has spread to nearby lymph nodes. A skin graft — a section of skin from another area of the body — may be needed after the removal of a large melanoma or multiple melanomas in one area to ensure that the surgical wound is adequately covered.

Surgical removal of the melanoma

In most cases, the recommended surgical procedure to remove a primary melanoma is a procedure known as a wide local excision. With this procedure, the melanoma is removed along with a measured area of normal skin and underlying fatty tissue around and below the melanoma. The normal tissue is removed as a precaution; if any melanoma cells have started to spread beyond the original site, they will likely be removed with the normal tissue. This normal tissue is called the surgical margin, and the width of the margin depends on the thickness of the melanoma (see Table 1, Figure 1). It was once thought that an even wider excision was necessary, but research has shown that the currently recommended surgical margins offer a better cosmetic result while still providing the same level of safety and effectiveness.

Table 1. Recommended surgical margins for excision of melanoma

Melanoma thickness Recommended excision margin
In situ 0.5 cm
≤1.0 mm 1.0 cm
1.01-2 mm 1-2 cm
2.01-4 mm 2 cm
>4 mm 2 cm

 

Surgical removal of lymph nodes and SLN biopsy

In approximately one in five patients with melanomas thicker than 1 millimeter, the melanoma has already spread to the lymph nodes by the time of initial diagnosis. In some instances, the doctor may suspect melanoma has spread to nearby lymph nodes because he or she could feel one or more enlarged nodes during the physical examination, or they can be seen on an X-ray or other imaging study. A needle biopsy may be necessary to confirm that melanoma has spread to the lymph nodes. If lymph nodes contain melanoma cells, they are removed in a procedure called a lymph node dissection, or lymphadenectomy.

If the physical examination and imaging studies are normal, a procedure known as lymph node mapping and SLN biopsy may be performed. This procedure helps determine if a lymph node dissection is needed and helps prevent unnecessary lymph node removal in certain cases. A complete lymph node dissection is recommended if the SLN is positive (melanoma cells are detected). With this procedure, the surgeon will remove all the lymph nodes in the group of nodes nearest the melanoma. The largest groups of lymph nodes are found in the groin (inguinal nodes), the armpit (axillary nodes), the neck (cervical nodes) and above the collarbone (supraclavicular nodes).

The two most common side effects of lymph node dissection are wound complications (such as infection) and lymphedema. Lymphedema is a buildup of lymph fluid in an area that occurs because lymph fluid cannot drain properly if lymph nodes are removed (see Figure 2). This causes swelling in a limb (arm or leg), which can be uncomfortable and restrict activity. You can learn more about lymphedema here.

Figure 2

Additional Resources

 

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