Melanoma surgery

For melanoma of the skin, wide local excision removes the melanoma with a border of surrounding skin, called a surgical margin. The margin depends on how deeply the melanoma has grown, its subtype and its location, including the need to protect appearance and function. Sentinel lymph node biopsy is a separate staging procedure: a sample from the first draining lymph nodes helps assess whether the melanoma has spread. Staged excision is another approach to checking the margins; further tissue may need to be removed before the area is clear.

Surgery is a central treatment for the original melanoma in the skin. Whether to add sentinel lymph node biopsy depends partly on tumour thickness. It is recommended for melanomas at least 1 mm thick and may be considered for those 0.8–1 mm thick, or thinner melanomas with ulceration, meaning a breakdown of the surface. Other adverse features can also affect this decision.

For melanoma that has spread, the treatment plan can combine surgery with immunotherapy, which acts through the immune system, or targeted medicines. Close monitoring rather than automatic removal of all the remaining lymph nodes is an option in selected patients whose sentinel node contains melanoma. These are different decisions from removing the original skin tumour.

For melanoma on the outer ear, preserving the cartilage can help retain the ear’s shape and function. Whether preserving or removing cartilage gives better cancer control remains inconclusive, so neither approach can be presented as the better cancer treatment for everyone.

Follow-up imaging can help find melanoma that has returned at the scar before it is apparent on clinical examination. At one specialist centre, 320 patients with skin melanoma had 730 high-frequency ultrasound examinations of their excision scars between November 2024 and October 2025. Of 53 scars judged suspicious, 50 had melanoma confirmed by tissue testing and three had non-cancerous tissue changes. No missed recurrences were observed among ultrasound-negative scars during follow-up lasting a median of 12 months, with a range of 3–12 months. These findings concern detection in an expert setting, not the chance of cure after surgery or proof that ultrasound improves survival.

Lymph node surgery can lead to infection, reopening of the wound, collections of lymph fluid called lymphoceles, and swelling caused by impaired lymph drainage, called lymphoedema. These complications were documented in melanoma patients undergoing lymph node surgery in Peru; they are not estimates of risk from skin excision alone.

Staged excision can require more than one removal of tissue to achieve clear margins. Larger areas of removal can also require more complex wound repair. This occurred in patients treated for melanoma confined to the surface layer of skin and for invasive melanoma, mostly on the head and neck.

Some melanoma excision wounds are repaired with a skin graft, using skin taken from another part of the body. Follow-up may also involve checking the excision scar. In the specialist ultrasound pathway described here, suspicious scar changes led to a biopsy or excision for tissue testing, uncertain changes led to an earlier repeat assessment, and scars that appeared benign continued under monitoring. This is an example of specialised follow-up rather than a universal timetable for everyone after melanoma surgery.