Surgery is the main treatment option for most cases of melanoma, and is usually curative for early stage melanomas.

Simple excision

Thin melanomas can be completely cured by a fairly minor surgery called simple excision. The tumor is 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.

Simple excision differs from an excisional biopsy. The margins are wider because the diagnosis is already known. The margins should be anywhere from 0.5 centimeters (cm) (about ¼ inch) to nearly an inch depending on the thickness of the tumor. Thicker tumors call for larger margins.

Tumor thickness	Recommended margins
In situ	0.5 cm
Less than 1 mm	1 cm
1 to 2 mm	1 to 2 cm
2 to 4 mm	2 cm
Over 4 mm	At least 2 cm

Local anesthesia is injected into the area to numb it before the excision. The wound is carefully stitched back together afterwards. This will leave a scar.

Re-excision (wide excision)

When a diagnosis of melanoma is made by biopsy, the site will likely need to be excised again. More skin will be cut away from the melanoma site, and the sample will be viewed under a microscope to make sure that no cancer cells remain in the skin. The size of the margin depends on the thickness of the tumor (see the table above).

If the melanoma is on the face, the margins may be smaller to avoid disfigurement. In some cases, the surgeon may use Mohs surgery (although not all doctors agree on its use for melanoma). In this procedure, the skin (including the melanoma) is removed layer by layer. Each layer is 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 as much of the cancer as possible while conserving the surrounding skin tissue.

Amputation

If the melanoma is on a finger or toe, the treatment may mean amputation of all or part of that digit. At one time, some melanomas of the arms and legs were also treated by amputation, but this is no longer done. Studies have shown that wide excision of arm and leg melanomas is as effective as amputation.

Lymph node dissection

A lymph node dissection surgically removes the lymph nodes in the region most likely to contain any spreading melanoma cells. (For example, if a skin melanoma is found on a leg, lymph node dissection would remove the nodes in the groin region on that side of the body, which is where melanoma cells would most likely travel to.) The nodes are then viewed under a microscope to see how many of them contain cancer.

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 of the melanoma, this may be done by physical exam and/or by imaging tests to look at nodes that are not near the surface.

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

If the lymph nodes are not enlarged, then a sentinel lymph node biopsy may be done, particularly if the melanoma is thicker than 1 mm. (See the section, "How is melanoma diagnosed?" for a description of this procedure.) If the sentinel lymph node does not show 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 is positive for cancer, removal of the remaining lymph nodes in that area is usually advised.

Although clinical trials are in progress, doctors do not know whether finding and removing lymph nodes that may have cancer cells is life-saving. Still, some doctors feel it may prolong a patient's survival and at least avoid the pain that may be caused by cancer growing in these lymph nodes. Its main benefit at this point is to help determine a patient's outlook.

A full lymph node dissection can cause some upsetting 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, leading to limb swelling, which may or may not go away over time. Elastic stockings or compression sleeves can help some people with this condition. Sometimes special devices that squeeze the limbs are used and may be helpful. For more information, see the separate American Cancer Society document, Understanding Lymphedema (For Cancers Other Than Breast Cancer).

Lymphedema, along with the pain from the surgery itself, is why lymph node dissection is not done unless the doctor thinks 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 these procedures done.

Surgery for metastatic melanoma

Once 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, other areas of metastasis are likely to be present that are too small to be found by these scans. Surgery is sometimes done in these circumstances, although 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 completely removed, this surgery may help some patients to live longer. Removing metastases in some areas, such as the brain, might also relieve symptoms and help improve the patient's quality of life.

Last Medical Review: 06/05/2008
Last Revised: 05/14/2009