Surgery is the most common and effective treatment for melanoma. The surgical procedure used depends on the stage and location of the cancer, the patient’s overall health, and a variety of other factors that your provider will discuss with you.
Surgical excision involves an excision at the primary site of the cancer. A border of skin around the melanoma is also removed. This skin is the margin, which is examined under a microscope to be sure all the cancerous cells have been removed and that the cancer has not spread. The size of the margin depends on the extent of the melanoma.
Stage 0 melanomas have not grown deeper than the epidermis. They’re usually treated by surgically removing the melanoma and a small margin of about ½ centimeter of normal skin.
Stage I melanoma is treated by surgically removing the melanoma, as well as a larger margin of healthy skin. The amount of normal skin removed depends on the thickness of the melanoma. Typically, not more than two centimeters of healthy skin is removed from all sides of the melanoma in stage I. Wider margins make healing more difficult and have not proven beneficial for many patients.
For stage II melanoma, a procedure called wide excision is the standard treatment. The amount of margin or normal skin removed from around the tumor site is based on the thickness of the melanoma.
Because the cancer may have spread to lymph nodes near the melanoma, many providers recommend a sentinel lymph node biopsy. The sentinel node is the first lymph node where the primary melanoma drains cancer cells in to the lymph system. If the sentinel node is found, then it will be biopsied when the melanoma is removed. If the sentinel node contains cancer, then a lymph node dissection may be performed to remove affected lymph nodes.
In some cases of stage II melanoma, for example if a tumor is found to be more than four millimeters thick or if lymph nodes do contain cancer, some providers may suggest additional treatment, called adjuvant therapy, after surgery.