From the Guidelines
Surgical excision with histologically negative margins is the recommended and first-line treatment for primary cutaneous melanoma, with margins based on tumor thickness. The specific type of excision depends on the melanoma's depth and location. For early melanomas, a wide local excision with margins of 0.5-2 cm is typically performed under local anesthesia 1. For deeper melanomas, wider margins may be necessary, and a sentinel lymph node biopsy might be performed simultaneously to check if cancer has spread to nearby lymph nodes. In some cases, Mohs micrographic surgery may be used for melanomas in cosmetically sensitive areas, though this is less common than for other skin cancers 1.
Some key points to consider when performing surgical excision for melanoma include:
- For invasive melanomas, surgical margins should be at least 1 cm and no greater than 2 cm, depending on tumor thickness 1
- For melanoma in situ, wide excision with 0.5- to 1.0-cm margins is recommended 1
- Sentinel lymph node biopsy should be performed before wide excision of the primary tumor, and in the same operative setting, whenever possible 1
- Mohs micrographic surgery or staged excision with paraffin-embedded permanent sections may be utilized for melanoma in situ on the face, ears, or scalp for tissue-sparing excision and exhaustive histologic assessment of peripheral margins 1
After removal, the specimen is sent to pathology to confirm complete excision of the tumor. The wound may be closed directly, require a skin graft, or heal by secondary intention depending on its size and location. Surgical excision remains the gold standard treatment because it allows for complete removal of the tumor with histological confirmation and has the highest cure rates for melanoma 1.
From the Research
Skin Removal Techniques for Melanoma
The following skin removal techniques are used to remove melanoma:
- Wide Local Excision (WLE): This technique involves the removal of the melanoma along with a safety margin of surrounding skin and subcutaneous tissue 2.
- Mohs Micrographic Surgery (MMS): This technique involves the removal of the melanoma layer by layer, with each layer being examined under a microscope until no cancer cells are found 3, 4, 5, 6.
- Staged Excision: This technique involves the removal of the melanoma in stages, with each stage being examined under a microscope until no cancer cells are found 3.
Comparison of Skin Removal Techniques
Studies have compared the effectiveness of WLE, MMS, and staged excision in removing melanoma:
- A systematic review and meta-analysis found that MMS and staged excision had lower local recurrence rates compared to WLE 3.
- A retrospective chart review found that MMS was associated with decreased rates of local recurrence compared to WLE for melanoma of the head and neck 4.
- A retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) cancer registry found that MMS and WLE had similar cancer-specific survival rates and overall survival rates for melanoma in situ of the head and neck region 5.
- Another retrospective analysis of the SEER cancer registry found that MMS and WLE had similar cancer-specific survival rates and overall survival rates for melanoma in situ 6.