Melanoma Surgery

Diagnosis and Biopsy

Diagnosing melanoma begins with a thorough physical examination of the skin, focusing on any abnormal moles or lesions. If a suspicious area is found, a biopsy is performed to confirm the presence of cancer cells. The most common method is an excisional biopsy, where the entire lesion and a small margin of surrounding skin are removed for analysis.

Very occasionally, a punch or incisional biopsy may be used, especially if the lesion is large and in a challenging location such as the face. Early-stage melanoma is often detected through an excision biopsy, which is crucial for full analysis of the melanoma, effective treatment and a better prognosis. Identifying melanoma at an early stage allows for prompt intervention and increases the likelihood of successful outcomes.

More About Melanoma Surgery and Wide Local Excision

Melanoma surgery typically begins with a biopsy to confirm the diagnosis. Once melanoma is diagnosed, there is further surgery to remove a wider margin of tissue around the tumour to ensure all cancer cells are removed and reduce the risk of local recurrence. For stage 0 melanoma (pre-cancerous), at least 0.5cm of tissue is removed around the tumour, and for stage 1 and above, at least 1cm.

The surgeon removes more tissue based on how much tissue is needed, which primarily depends on the melanoma’s depth (Breslow thickness). In some cases, sentinel lymph node biopsy may be offered at the same time to determine if the melanoma has spread.

Reconstructive surgery, such as skin grafts or skin flaps, may be performed to repair the surgical site and improve cosmetic outcomes. A skin flap is a piece of tissue that is moved from a nearby area and maintains its original blood supply, while a skin graft involves taking skin from a donor site and placing it onto the wound, where it forms a new blood supply.

Lymph Node Involvement

Lymph nodes are small, bean-shaped structures that play a vital role in the body’s immune system. In melanoma, these nodes are important because melanoma cells can break away from the primary tumour and travel to nearby lymph nodes.

This spread is a key factor in determining the stage of melanoma and influences treatment decisions and prognosis. For stage 1B and above melanomas, the surgical procedure of sentinel lymph node biopsy is offered to determine if there has been spread of melanoma.

Assessing lymph node involvement helps doctors understand how far the melanoma has progressed and whether additional oncology treatment, such as targeted therapy or immunotherapy, may be necessary. Determining lymph node involvement is essential for managing melanoma and planning the most effective treatment strategy.

What Results Are Typically Achieved in Melanoma Skin Cancer

The primary goal of melanoma surgery is the complete removal of cancerous cells to prevent further spread. Complete removal with adequate surgical margins reduces the risk of melanoma coming back.

Patients can expect to have the melanoma excised and may achieve a good cosmetic outcome with minimal scarring, depending on the size and location of the melanoma. Sentinel lymph node biopsy usually has a good outcome, and the main risks are slow wound healing or a fluid collection (seroma / lymphocele).

If the primary melanoma is advanced or the melanoma has spread, oncology treatment with targeted therapy or immunotherapy may be offered by an oncologist. Follow-up care is standard following a melanoma diagnosis, and monitoring is essential to detect any recurrence early. If recurrence is detected during follow-up, further treatment may be necessary.