Melanoma Skin Cancer

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Treating Skin Cancer - Melanoma TOPICS

Surgery for melanoma skin cancer

Surgery is the main treatment option for most melanomas, and usually cures early stage melanomas.

Wide excision

When a diagnosis of melanoma is made by skin biopsy, the site will probably need to be excised again to help make sure the cancer has been removed completely. This fairly minor surgery will cure most thin melanomas.

Local anesthesia is injected into the area to numb it before the excision. The tumor is then cut out, along with a small amount of normal non-cancerous skin at the edges. The normal, healthy skin around the edges of the cancer is referred to as the margin. The wound is carefully stitched back together afterward. This will leave a scar.

The removed sample is then viewed under a microscope to make sure that no cancer cells remain at the edges of the skin that was removed.

Wide excision differs from an excisional biopsy. The margins are wider because the diagnosis is already known. The recommended margins vary depending on the thickness of the tumor. Thicker tumors call for larger margins.

    Tumor thickness

    Recommended margins

 

    In situ

    0.5 cm

    1 mm or less

    1 cm

    1 to 2 mm

    1 to 2 cm

    2 to 4 mm

    2 cm

    Over 4 mm

    2 cm

These margins might need to be altered based on where the melanoma is on the body and other factors. For example, if the melanoma is on the face, the margins may be smaller to avoid large scars or other problems. Smaller margins may increase the risk of the cancer coming back, so be sure to discuss the options with your doctor.In some cases, the surgeon may use Mohs surgery, but not all doctors agree on its use for melanoma. In this procedure, the skin (including the melanoma) is removed in very thin layers. Each layer is then viewed under a microscope for signs of cancer. The operation continues until a layer shows no signs of cancer. In theory, this allows the surgeon to remove the cancer while saving as much of the surrounding normal skin as possible.

If the melanoma is on a finger or toe and has grown deeply, the treatment may require amputation of all or part of that digit.

Lymph node dissection

In this operation, the surgeon removes all of the lymph nodes in the region near the primary melanoma. For example, if a skin melanoma is found on a leg, the surgeon would remove the nodes in the groin region on that side of the body, which is where melanoma cells would most likely travel to first.

Once the diagnosis of melanoma is made from the skin biopsy, the doctor will examine the lymph nodes nearest the melanoma. Depending on the thickness and location of the melanoma, this may be done by physical exam, or by imaging tests (such as CT or PET scans) to look at nodes that are not near the body surface.

If the nearby lymph nodes feel abnormally hard or large, and a fine needle aspiration (FNA) biopsy or excisional biopsy finds melanoma in a node or nodes, a lymph node dissection is usually done.

If the lymph nodes are not enlarged, a sentinel lymph node biopsy may be done, particularly if the melanoma is thicker than 1 mm. (See the section “How is melanoma of the skin diagnosed?” for a description of this procedure.) If the sentinel lymph node does not contain cancer, then it is unlikely the melanoma has spread to the lymph nodes and there is no need for a lymph node dissection. If the sentinel lymph node contains cancer cells, removing the remaining lymph nodes in that area with a lymph node dissection is usually advised. This is called a completion lymph node dissection.

It is not clear if a lymph node dissection can cure melanomas that have spread to the nodes. This is still being studied. Still, some doctors feel it might prolong a patient’s survival and at least avoid the pain that may be caused by cancer growing in these lymph nodes.

A full lymph node dissection can cause some long-term side effects. One of the most troublesome is called lymphedema. Lymph nodes in the groin or under the arm normally help drain fluid from the limbs. If they are removed, fluid may build up. This can cause limb swelling, which may or may not go away. If severe enough, it can cause skin problems and an increased risk of infections in the limb. Elastic stockings or compression sleeves can help some people with this condition. For more information, see our document Understanding Lymphedema (for Cancers Other Than Breast Cancer).

Lymphedema, along with the pain from the surgery itself, is a main reason why lymph node dissection is not done unless it is necessary. Sentinel lymph node biopsy, however, is unlikely to have this effect. It is important to discuss the possible risks of side effects with your doctor before having either of these procedures done.

Surgery for metastatic melanoma

If melanoma has spread from the skin to distant organs such as the lungs or brain, the cancer is very unlikely to be curable by surgery. Even when only 1 or 2 metastases are found by imaging tests such as CT or MRI scans, there are likely to be other areas of metastasis that are too small to be found by these scans.

Surgery is sometimes done in these circumstances, but the goal is usually to try to control the cancer rather than to cure it. If 1 or even a few metastases are present and can be removed completely, this surgery may help some people live longer. Removing metastases in some places, such as the brain, might also relieve symptoms and help improve the person’s quality of life.

If you have metastatic melanoma and surgery is offered as a treatment option, talk to your doctor and be sure you understand what the goal of the surgery would be, as well as its possible benefits and risks.


Last Medical Review: 10/29/2013
Last Revised: 09/05/2014