Treatment for early melanoma

Surgery (wide local excision)

After an excision biopsy, most people diagnosed with melanoma will require a second surgery to remove more skin from around the melanoma. This is known as a wide local excision and is the main treatment for early melanoma.

Removing more skin around the melanoma reduces the risk of it coming back (recurring) at that site. The width of the margin is usually 5–10 mm, depending on the type, thickness and location of the melanoma. For thicker tumours, or tumours with certain characteristics, a wider margin of up to 20 mm may be advised.

A wide local excision is often performed as a day procedure, so you can go home soon after the surgery if there are no complications. If the melanoma is thicker than 1 mm or is considered to have a high risk of spreading to the lymph nodes, the doctor will discuss the risks and benefits of having a sentinel lymph node biopsy.

If you need a sentinel node biopsy, it is done at the same time as the wide local excision.

Checking for a clear margin

After a wide local excision, the tissue removed from around the melanoma will be sent to a laboratory. The pathologist will check that the required margin has been taken – this is called a clear margin. If the margins need to be wider, you may need to have further surgery to remove more tissue.

Reparing the wound

The wound is often closed with stitches. You will have a scar but this will usually become less noticeable with time. If a large area of skin is removed, the surgeon may repair the wound using skin from another part of your body. This can be done in 2 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 (most often the thigh or neck) and placed over the area where the melanoma was removed. The skin grows back quickly, usually over a few weeks.

Whether the surgeon does a skin flap or graft will depend on a number of factors, including where the melanoma was and how much tissue has been removed. In either case, the wound will be covered with a dressing. After several days, the doctor will check to see if the wound is healing properly. If you had a skin graft, you will also have a dressing on any area that had skin removed for the graft.

Removing lymph nodes

Many people with early melanoma will not need to have any lymph nodes removed. But if lymph nodes do need to be removed, these are a few ways it can be done: 

Sentinel lymph node biopsy – If the melanoma is thicker than 1 mm or has high-risk features, you may have a sentinel lymph node biopsy at the same time as the wide local excision.

Further scans and treatment – If a sentinel lymph node biopsy shows melanoma in the removed node, you will need to have regular imaging scans to check that the melanoma has not come back or spread. You may also be offered drug therapy to reduce the risk of the melanoma returning.

Lymph node dissection – If your lymph nodes feel or look swollen, and a fine needle biopsy confirms that a lymph node contains melanoma, you may need to have all the lymph nodes in that area removed under a general anaesthetic. This operation is called a lymph node dissection or lymphadenectomy, and may mean a longer stay in hospital.

Side effects of lymph node removal

Having your lymph nodes removed can cause side effects. These can be milder if you have a sentinel lymph node biopsy compared with having all of the lymph nodes from an area removed (lymph node dissection).

Wound pain – Most people will have some pain after the operation, which usually improves as the wound heals. Sometimes, the pain may last longer or be ongoing. Talk to your treatment team about how to manage any pain.

Neck/shoulder/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. It may help to do gentle exercises or ask your GP or treatment team to refer you to a physiotherapist.

Seroma/lymphocele – This is a collection of fluid in the area where the lymph nodes have been removed. It is a common side effect and usually appears 7–10 days after surgery. It usually gets better after a few weeks, but sometimes fluid may need draining with a needle.

Lymphoedema – This is a swelling of the neck, arm or leg that may appear after the lymph nodes are removed. Lymphoedema happens when lymph fluid builds up in the affected part of the body because the treatment has damaged or blocked the lymphatic system.

Further treatment before or after surgery

If there’s a risk that the melanoma could come back (recur) after surgery, other treatments are sometimes used to reduce the risk. These are known as neoadjuvant treatments if used before surgery and adjuvant (or additional) treatments if used after. They may be used alone or together.

Treatments that enter the bloodstream are used if there is a risk a tumour will come back in other parts of the body (further from the regional sites). These are known as drug therapies or systemic treatment.

The main drug therapies for melanoma are:

• immunotherapy – drugs that use the body’s own immune system to recognise and fight some types of cancer cells; can be used before or after surgery
• targeted therapy – drugs that attack specific features within cancer cells, known as molecular targets, to stop the cancer growing and spreading; usually given after surgery.

Rarely, radiation therapy will be used after surgery if there’s a risk the tumour could come back at the original site or to the nearby lymph nodes. Radiation therapy is the use of targeted radiation to damage or kill cancer cells in a particular area of the body.

Continue reading for further information about immunotherapy, targeted therapy and radiation therapy, or read through our fact sheets below.

Key points about treating early melanoma

What it is - Melanoma is a type of skin cancer. Early melanoma (also called localised) has not spread outside the primary site. Regional melanoma has spread to nearby lymph nodes, skin or tissue.

The main treatment - The main treatment is surgery to remove the suspicious area. Most people will have further surgery to remove more normal-looking tissue from around the melanoma (wider margin).

Removing lymph nodes - Many people with early melanoma will not need to have any lymph nodes removed. But if melanoma has high-risk features or has spread to the lymph nodes, you could have one of the following procedures:

• sentinel lymph node biopsy – removes the lymph nodes that a melanoma may have spread to first, helps to detect the spread as early as possible
• lymph node dissection or lymphadenectomy – removes lymph nodes if a fine needle biopsy shows the melanoma has spread to them and caused lumps.

Further treatment - You may also have other treatments to reduce the risk of the melanoma coming back. This may be before (neoadjuvant) or after (adjuvant) surgery, and may include:

• immunotherapy – drugs that use the body’s own immune system to fight melanoma
• targeted therapy – drugs that attack specific features of the melanoma cells to stop the them growing and spreading.