How is melanoma removed?

Author: Vanessa Ngan, Staff Writer; Copy Editor: Clare Morrison; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, October 2013. About Melanoma is sponsored by the New Zealand Dermatological Society Incorporated.

Melanoma is removed surgically by excision, which means cutting it out. The goal is to remove all of the melanoma cancer cells. This is often done as two procedures.

Diagnostic excision removes the cancer

If your doctor suspects a skin spot is a melanoma, it is cut out with a small margin (usually about 2 mm) of normal skin surrounding it. This may be done by your family doctor, or you may be referred to another doctor for the procedure. This is called a diagnostic excision. The cut-out tissue is sent to a pathology lab for testing.

Re-excision ensures none is left behind

If the pathology report is positive for melanoma, a second procedure usually takes place a few weeks later. This is to make sure the melanoma has been completely removed and includes removing a larger margin of normal tissue.

The size of the re-excision margin depends on the Breslow thickness measured by the pathologist and the site of the melanoma. Sometimes it is difficult to achieve recommended margins in sites such as the mid-face.

Re-excision may be done by your family doctor if the melanoma is in situ (Stage 0) or thin and less than 1 mm in thickness (Stage IA). Otherwise you will be referred to a dermatologist or a surgical specialist for further management.

How much skin will be removed when I have the re-excision?

The re-excision will remove the wound or scar from the diagnostic excision, with a margin of normal skin measured at the time of surgery, as shown in the table below. 

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Tell me more about the surgery

Simple excision and repair

In most cases, melanoma is cut out by simple excision.

Excision with complex repair

Some large wounds cannot be repaired by simply drawing the edges together and stitching them up. In these cases the defect may require a skin flap or skin graft. Your doctor will explain the procedure to you.

Mohs micrographic surgery

Mohs surgery is a surgical technique used by specially trained dermatologists for some facial skin cancers, including a type of melanoma called lentigo maligna.


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