Surgery is the main tool for diagnosing and treating melanoma skin cancer in its early stages. There are several types, and they are usually outpatient procedures.

After removing the affected tissue, a specialist surgeon or dermatologist sends the sample to a laboratory for testing. Then, they decide if further attention is necessary and discuss the findings with the individual.

Advances in melanoma skin cancer surgery mean that doctors can often use less invasive methods to remove a lesion. In planning treatment, a doctor will prepare a tailored approach that suits the person’s needs.

This article discusses the types of surgery available for people with melanoma skin cancer.

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A person may need a biopsy to confirm the diagnosis of melanoma before planning other more extensive surgical treatments. The choice of surgery will depend on the extent and type of lesion, among other factors.

Excisional biopsy

This is a diagnostic procedure that involves removing all or part of a lesion to test for melanoma. If melanoma is present in the biopsy, a person may need further surgery.

  • clean and numb the lesion with a local anesthetic
  • remove the lesion — for example, by cutting it
  • apply stitches, if necessary, and a dressing
  • send the sample to a laboratory for testing

The doctor will arrange to share the results with the individual.

Risks

There is a small risk of bleeding, pain, infection, and dry itchy skin. A healthcare professional can advise on wound care and when to seek help.

Recovery

A skin biopsy wound usually heals in 7 to 10 days.

Mohs

For very early stage melanoma, a doctor may recommend a Mohs procedure, also known as Mohs micrographic surgery (MMS).

Mohs may be suitable if melanoma affects an area where wider surgery is difficult, such as the face or ears.

It involves:

  1. Applying a local or general anesthetic.
  2. Removing the skin, including the lesion, in very fine layers.
  3. Freezing and inspecting each layer in turn under a microscope.
  4. Continuing to remove layers until no more cancer cells are visible.

The procedure can take several hours but is more focused and less disruptive to the surrounding skin than other treatments.

Risks

After the procedure, risks can include pain, infection, bleeding, and scarring. Larger lesions may require a skin graft, in which a doctor takes skin from another part of the body to help the wound heal.

Recovery

The surgical site can be painful. People can expect pain to decrease over the first week or so post-procedure, and it can take several weeks to months for the wound to heal.

For some, the wound can take up to a year to heal fully. The recovery time depends on the person and if they have any risk factors that affect wound healing, such as having diabetes.

Wide local excision

Wide local excision (WLE) surgery may be appropriate if a biopsy has already shown signs of melanoma. It aims to remove all cancer cells from an area.

Wide local excision is more invasive than MMS and is likely to leave a larger scar. However, it is still a fairly minor procedure.

To perform a WLE, a doctor will:

  • inject a local anesthetic
  • cut out the tumor with a margin of unaffected skin around it
  • stitch the wound

Surgery aims to remove the tumor and any surrounding skin that may contain melanoma cells. For this reason, the thicker the tumor, the wider and deeper the margins will need to be.

The margins may need to be smaller in sensitive areas, such as the face. The doctor will advise on monitoring for future changes, especially if the margins are small.

Risks

Risks can include infection, bleeding, itching, and pain.

Recovery

Most people feel better after a few days, but wound recovery can take several weeks or months. Healing time can depend on the size and depth of the wound and individual factors.

Sentinel lymph node biopsy

A doctor may perform a sentinel lymph node biopsy (SLNB) if they suspect melanoma has reached the lymph nodes. A key way for cancer cells to spread throughout the body is via the lymphatic system. If cells are in the lymph nodes, cancer may have spread further.

The SLNB procedure involves removing one sentinel lymph node for testing. Cancer spreads to this node before moving to other nodes.

If the sentinel lymph node tests negative, the cancer is highly unlikely to have spread further.

Risks

Possible risks include a condition called lymphedema, a lump due to a buildup of lymph fluid, pain, bruising, infection, and difficulty moving nearby limbs.

Recovery

Recovery can take from a few days to a few weeks.

Total lymph node dissection

Previously, total or complete lymph node dissections (TLND) were considered the next step after positive SLNB results, but 2024 research shows no benefit to long-term survival.

In a TLND, the doctor removes all the lymph nodes in an area, for instance, under one arm.

At present, most doctors do not recommend this procedure, especially since it has debilitating side effects, such as lymphedema, which can greatly affect a person’s quality of life.

Risks

There is a long-term risk of lymphedema, numbness, and difficulty moving nearby body parts. Other risks include possible infection, bleeding, and pain after surgery.

Recovery

This can take several weeks, depending on the extent and location of the surgery. Recovery after underarm total lymph node removal can take 4 to 6 weeks.

The above options can treat and manage melanoma skin cancer. For stages 0 to 2, experts consider WLE to be a cure. For more advanced melanomas, doctors can combine WLE with other treatments, such as immunotherapy.

Metastatic melanoma is melanoma that has spread beyond the skin. It can develop in several places, and some may not appear on an imaging scan, making surgery difficult.

At this stage, a doctor will recommend other options, such as immunotherapy or targeted therapy. These methods can target cancer throughout the body.

Here are some questions people often ask about surgery for melanoma skin cancer.

Can melanoma spread after being removed?

Melanoma cannot spread after removal, but undetected melanoma cells can sometimes remain after surgery. Therefore, it is best to monitor the skin regularly and follow any other treatment the doctor advises.

It is important for people to have very regular skin exams, especially in the first and second year after surgery for melanoma.

What kind of surgery is there for melanoma?

Surgery is usually local and limited, but the extent of the incision will depend on the size of the lesion. A biopsy excision, Mohs surgery, sentinel lymph node biopsy, and wide local excision are common procedures that can diagnose and treat melanoma.

Can you live a full life after melanoma?

For many people with melanoma, treatment can remove the cancer. However, for others, the melanoma may never fully go away. According to the American Academy of Dermatology, the 5-year relative survival rate for melanoma is 94% when detected and treated early.

Surgery can successfully remove melanoma skin cancer lesions in many cases. The choice of surgery will depend on various factors, such as how far the cancer has spread.

After surgery for melanoma skin cancer, a person should regularly check their skin and nearby lymph nodes for additional changes.