Types of surgery for melanoma skin cancer

Surgery is the main treatment for most melanomas. It can often cure early stage melanomas.

Simple excision

Thin melanomas can often be cured by a fairly minor operation called simple excision. After the skin is numbed, the tumor is cut out, along with a small amount of normal skin at the edges (called the margin). The wound is then stitched closed. This surgery will leave a scar.

Wide-excision (re-excision)

If melanoma was confirmed by biopsy, the area will need to be excised (removed) again. More skin will be cut away from the area around the melanoma, and the tissue will be looked at under a microscope to make sure that no cancer cells are left in the skin.

If the cancer is on the face, a smaller amount of tissue may be removed. A method called Mohs surgery may be used. In this approach the cancer is removed in very thin layers until the tissue shows no signs of cancer. But not all doctors agree on the use of Mohs surgery for melanoma.

If the melanoma is on a finger or toe, the treatment may require that all or part of that digit be removed.

Lymph node dissection

In the past, a lymph node dissection was sometimes done to see if the melanoma had spread to the nodes. Today, a sentinel lymph node biopsy (see the section “How is melanoma of the skin found?”) is done first because it is a smaller surgery that is less likely to cause side effects such as lymphedema (see below).

If the sentinel node does not show cancer, then the disease has most likely not spread to other nodes and there is no need to remove lymph nodes.

If the sentinel lymph node does show cancer, then a lymph node dissection will likely be done to remove the other nodes in that area. 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 life and at least avoid the pain that may be caused by cancer growing in these lymph nodes.

Removing lymph nodes can cause some long-term side effects. The most troublesome is called lymphedema. Lymph nodes help drain fluid from the arms and legs. If the lymph nodes are removed, fluid can build up, leading to limb swelling. This side effect, along with the discomfort of the surgery itself, is the reason lymph nodes are not removed unless the doctor thinks it’s necessary. To find out more, see our document called Understanding Lymphedema (for Cancers Other Than Breast Cancer).

Surgery for melanoma that has spread

When the melanoma has spread from the skin to distant organs (such as the lungs or brain), the cancer is very unlikely to be cured by surgery. Even so, surgery is sometimes done because removing even a few areas of spread could help some people to live longer or have a better quality of life. If you have metastatic melanoma and your doctor recommends surgery, be sure you understand what the goal of the surgery would be.