Surgery for Melanoma Treatment

Melanomas Less Than 1 Millimeter Thick

The most commonly performed procedure is a wide excision of the primary tumor. The surgeon carefully cuts out the melanoma and a predetermined area around it. The amount of skin that is removed and the degree of scarring depend on the thickness of the melanoma tumor. Most patients usually do not need more treatment.

Depending on the melanoma size, the local excision may be an in hospital or outpatient procedure, often with local anesthesia. Stitches may be required, and recovery can take a few weeks. Severity of the scar depends on the size, depth and location of the melanoma.

Based on how aggressive the melanoma looks under the microscope, your surgeon may discuss a procedure called lymphatic mapping and sentinel lymph node biopsy, a minimally invasive surgical approach in which the regional lymph node(s) that receive lymph drainage from the primary tumor site is/are removed and carefully checked for cancer spread to the regional nodes. These “sentinel” lymph nodes represent the most likely nodes to contain spread, if any are involved. If the sentinel lymph node is cancer free, then the other lymph nodes do not need to be checked or removed. If the sentinel lymph node contains melanoma spread (metastasis), your doctor may discuss further surgery and other treatment.

Melanomas More Than 1 Millimeter Thick

The principal procedure is a wide excision of the primary tumor. The surgeon carefully cuts out the melanoma and a predetermined area around it. The amount of skin that is removed and the degree of scarring depend on the tumor thickness of the melanoma. Most patients usually do not need more treatment.

If a large area of skin is removed during surgery, a skin graft may be done to reduce scarring. The surgeon numbs and removes a patch of healthy skin from another part of the body, such as the upper thigh, and then uses it to replace the skin that was removed. If you have a skin graft, you may need to take special care of the area until it heals.

In addition to a wide excision, your melanoma surgical oncologist will discuss a procedure called lymphatic mapping and sentinel lymph node biopsy, a minimally invasive surgical approach in which the regional lymph node(s) that receive lymph drainage from the primary tumor site is/are removed and carefully checked for cancer spread to the regional nodes. These “sentinel” lymph nodes represent the most likely nodes to contain spread, if any are involved. If the sentinel lymph node is cancer free, then the other lymph nodes do not need to be checked or removed. If the sentinel lymph node contains melanoma spread (metastasis), your doctor may discuss further surgery and other treatment such as immunotherapy.

Regional Lymph Node Metastasis

If melanoma has spread to the regional lymph nodes, a surgical procedure known as lymph node dissection (also termed lymphadenectomy) is often performed. This procedure consists of removal of the “compartment” of lymph nodes related to the location of where the tumor-containing lymph node was identified. This procedure is performed under general anesthesia; one or more drain tubes are usually placed at the completion of surgery to facilitate recovery. Lymph node dissection has been linked to certain long-term side effects, including lymphedema, which may result in fluid buildup in the arms or legs.  

Depending on the extent of spread to the lymph nodes, radiation therapy may also be recommended to try to reduce the chance of the melanoma recurring in the regional nodes. Immunotherapy may also be recommended.

Metastatic Melanoma (Stage IV)

Surgery may sometimes be used to treat melanoma that has spread to distant parts of the body.