Surgery

Surgery is the mainstay of melanoma treatment when the melanoma is confined to the skin. If melanoma hasn’t spread anywhere microscopically, and it is surgically removed from the skin, you should be cured.

It’s important for the surgeon to get widely around the visible melanoma to remove it completely. Excising it only narrowly usually leaves microscopic melanoma cells behind in the skin, and they’ll tend to grow back and spread. For a thin melanoma with good prognostic features, surgery is often successful if a margin of normal tissue 1 centimeter (about a half inch) around the melanoma is removed. Many patients are surprised that this still means a fairly large incision. Deeper melanomas require a margin of normal tissue that is even bigger, often 2 cm (about an inch on all sides of the melanoma).

If your medical oncologist in consultation with your surgeon consider there to be a moderate or high chance of microscopic melanoma cells spreading to a nearby lymph node in your body, they may recommend that the surgeon also perform what is called a sentinel lymph node biopsy. Remember that melanoma often travels to lymph nodes before it spreads elsewhere, so catching it at the lymph node stage may prevent it from spreading further.

A sentinel lymph node biopsy, if needed, is usually performed at the same setting when the melanoma is widely excised from the skin. The surgeon injects some blue dye and a tiny amount of radioactive tracer into the skin area where the melanoma is located. The first lymph node nearby that turns blue and radioactive is considered the sentinel lymph node, and this is removed. Most of the time, if the melanoma did not travel to the sentinel lymph node, it has not traveled to other lymph nodes. The pathologist looks carefully at the sentinel lymph node, and if this does not contain melanoma cells, you should not need additional surgery.

Sometimes the pathologist finds that the melanoma did travel to the sentinel lymph node, however. If this has occurred, your medical oncologist and surgeon will be concerned that the melanoma could have spread to other lymph nodes, and possibly other tissues in the body. Your physicians will probably advise having other lymph nodes removed around the area that the sentinel lymph node was taken from, to remove melanoma in case it has spread to these lymph nodes. The goal is to provide you with the highest chance of cure.

The general surgeons, plastic surgeons, and head and neck surgeons in the North Bay Melanoma Program are experienced in providing these types of melanoma operations.