Melanoma that is found early (stages 0–II or localised melanoma) can generally be treated successfully with surgery. If the melanoma has spread to nearby lymph nodes or tissues (stage III or regional melanoma), treatment may also include removing lymph nodes and additional (adjuvant) treatments.

Surgery

Surgery to remove the mole is the main treatment for early melanoma, and it can also be the only treatment you need.

Wide local excision

Even though the excision biopsy to diagnose melanoma often removes the melanoma, a doctor or surgeon may also do a procedure called wide local excision. This means removing more normal-looking skin from around the melanoma (wider margin), which reduces the risk of it coming back at that site.

A pathologist will check the tissue around the melanoma for cancer cells. If the sample doesn't contain any cancer cells, it is called a clear margin. If the margins aren't clear, you may need further surgery. Most people recover quickly after a wide local excision to remove a melanoma, but you will need to keep the wound clean. 

Repairing the wound

Most people will be able to have the wound closed with stitches. You will have a scar, but this will become less noticeable with time.

If a large area of skin is removed, the wound may be too big to close with stitches. In this case, the surgeon may repair it using skin from another part of your body, which can be done in two ways:

• Skin flap – nearby skin and fatty tissue are lifted and moved over the wound from the edges and stitched.
• Skin graft – a layer of skin is taken from another part of your body (usually the thigh or neck) and placed over the area where the melanoma was removed.

The decision about whether to do a skin flap or graft 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. After several days, it will be checked to see if the wound is healing properly. If you had a skin graft, you will also have dressings on any area that had skin removed.

Removing lymph nodes

Many people with early melanoma will not need to have any lymph nodes removed.

In some cases, you may have a sentinel lymph node biopsy at the same time as the wide local excision. This removes the first lymph node that melanoma may have spread to. If melanoma is found, you will have regular imaging scans to check that it has not come back or spread. You may also be offered drug therapy to reduce the risk of the melanoma returning.

Occasionally, melanoma may spread to lymph nodes and cause lumps that your doctor can feel during a physical examination. If a fine needle biopsy confirms that a lymph node contains melanoma, that group of lymph nodes may be removed in an operation called a lymph node dissection or lymphadenectomy. This is performed under a general anaesthetic and requires a longer stay in hospital.

Side effects of lymph node dissection

Having your lymph nodes removed can cause side effects, such as:

• Wound pain – Most people will have some pain after the operation, which usually improves as the wound heals. For some people, the pain may be ongoing, especially if lymph nodes were removed from the neck.
• Neck/should/hip stiffness and pain – These are the most common problems if lymph nodes in your neck, armpit or groin were removed. You may find that you cannot move the affected area as freely as you could before the surgery.
• Seroma/lymphocele – This is a collection of fluid in the area where the lymph glands have been removed. It is a common side effect of lymph node surgery. Sometimes this fluid is drained by having a needle inserted into the fluid-filled cavity after surgery.
• Lymphoedema – If lymph nodes have been surgically removed, your neck, arm or leg may swell. 
  
  

Additional treatment

If there's a risk that the melanoma could come back (recur) after surgery, other treatments are sometimes used. These are known as adjuvant (or additional) treatment. They may be used alone or together.

Some treatments enter the bloodstream and travel throughout the body. This is known as systemic treatment, and includes:

• Immunotherapy – drugs that help the body's immune system to recognise and fight some types of cancer cells
• Targeted therapy – drugs that attack specific features within cancer cells known as molecular targets to stop the cancer growing and spreading.

In some cases, people may be offered radiation therapy, which is the use of targeted radiation to damage or kill cancer cells. Chemotherapy is rarely used for melanoma because immunotherapy and targeted therapy drugs usually work better.