Melanoma that is found early can generally be treated successfully with surgery. Your medical team will discuss the best treatment for you based on how far the melanoma has spread.
Surgery is the main treatment for early stage (localised) melanoma. Most of the time this is the only treatment needed.
A doctor or surgeon will do a procedure called wide local excision. This means that the area where the melanoma is, as well as a small amount of surrounding normal-looking skin will be cut out. This is called a safety margin, and is done to make sure all the cancer cells have been removed. The safety margin is usually between 5 mm and 1 cm, depending on the thickness and site of the melanoma. In some circumstances, a safety margin of up to 2 cm may be advised. The surgeon will stitch the wound closed.
A wide local excision is often performed as a day procedure using local anaesthetic. However, people with a melanoma thicker than 1 mm or with a Clark level of 4 or above will generally have a sentinel node biopsy at the same time and will be given a general anaesthetic. The sentinel node biopsy is not accurate if it is performed after the wide local excision has been done.
A pathologist will check the tissue around the melanoma for cancer cells. If the sample doesn’t have any cancer cells, it is called a clear margin. If the margins aren’t clear, you may need further treatment.
Most people will be able to have the surgical wound drawn together with stitches. If the wound is too big to close with stitches, the surgeon may cover it using some skin from another part of your body. This can be done in two ways:
The decision about whether to do a skin graft or flap will depend on many factors, such as where the melanoma is, how much tissue has been removed and your general health.
In either case, the wound will be covered with a dressing and left for several days. It will then be checked to see if it is healing properly. You will also have dressings on any area from which skin was taken for a graft.
You may be uncomfortable for a few days after a wide local excision. Your doctor will prescribe pain-killers if necessary. If you have a skin graft, the area on which the skin is grafted may look red and raw immediately after the operation. Eventually this area will heal and the redness will fade. Your medical team will tell you how to keep the wound clean to prevent it from becoming infected. Occasionally the original skin graft doesn’t take and a new skin graft is required.
Your total recovery time will vary depending on the thickness of the melanoma and the extent of the surgery required. Most people recover in a week or two. Your doctor can also give you information about any bruising or scarring you may have after surgery.
"I went to a doctor who specialises in facial and cosmetic surgery. He said it was important to get the melanoma out straightaway. He cut out a larger piece – about the size of a 20-cent coin – and it had clear margins. The cuts from surgery were able to heal into the folds and wrinkles of my face, so the scar is not noticeable." - John
If the melanoma has spread to your lymph nodes, they will be removed in an operation called a lymph node dissection or lymphadenectomy. The lymph nodes you have removed are likely to be near the location of the primary melanoma. There are large groups of lymph nodes in the neck, armpits and groin.
Like most treatments, having your lymph nodes removed can cause side effects such as:
If the lymph nodes have been surgically removed from the groin or armpit area, swelling of the leg, arm or neck on the same side is the most common problem. This is called lymphoedema and happens due to a build-up of lymph fluid in the affected part of the body.
The likelihood of lymphoedema following treatment depends on the extent of the surgery and whether you’ve had radiotherapy. It can develop a few weeks, or even several years, after treatment. Though lymphoedema may be permanent, it can usually be managed.
Occasionally, other treatments are used after surgery if there’s a risk that the melanoma could come back. These are known as adjuvant treatments. They may include radiotherapy, targeted therapies and immunotherapies, or you may be offered an opportunity to participate in a clinical trial.
For more information see treatment for advanced melanoma.
Reviewed by: Prof Bryan Burmeister, Director of Radiation Oncology, Princess Alexandra Hospital, QLD; Dr Victoria Atkinson, Senior Medical Oncologist, Division of Cancer Services, Princess Alexandra Hospital, QLD; Assoc Prof John Kelly, Head of Victorian Melanoma Service VIC; Dr Mark Hanikeri, Director WA Melanoma Advisory Service, Plastic and Reconstructive Surgeon, WA Plastic Surgery Centre WA; Lydia Visintin, Clinical Nurse Consultant, Melanoma Institute Australia NSW; Carol Hargreaves, 13 11 20 consultant, Cancer Council NSW; Julie Fraser, Peer Support Volunteer, Cancer Council QLD ; Susanna Cramb, Viertel Cancer Research Centre, Cancer Council QLD.