Following a melanoma diagnosis, your doctor will determine the best treatment plan based on tumor location, the stage of the cancer, and your general health. Surgery is almost always involved in the treatment plan for melanoma.

Melanoma Surgery by Stage

Surgery for melanoma is dependent upon the stage.

• For stage 0 and I cancers, surgical removal may be the only treatment required.
• For stage II cancers, surgery could also involve the removal of cancer-containing lymph nodes, and may be following by other treatments, such as immunotherapy or radiation, to decrease the likelihood of the melanoma returning.
• For stage III and IV cancers, surgery to remove the original tumor and cancer-containing lymph nodes may be followed by a number of treatment options with the goal of shrinking tumors, slowing disease progression, decreasing relapse risk, and potentially curing the disease.

Wide Excision Surgery for Melanoma

In wide excision surgery, your doctor will inject a local anesthetic then remove the cancerous tumor as well as a border of surrounding skin that is assumed to be healthy as a safety margin. The amount of “healthy” skin removed is determined by factors including the thickness of the melanoma (thicker tumors require bigger margins) and the location of the melanoma (tumors on the face may involve smaller margins to minimize scarring). A sample of the margin of skin removed is then sent to the laboratory to look for cancer cells.

Mohs Micrographic Surgery for Melanoma

Your surgeon may choose to perform Mohs micrographic surgery, which is a precise technique in which thin layers of skin containing cancer cells are removed and immediately examined until only tissue that is free of cancer is left. This procedure is intended to maximize the removal of cancerous tissue while minimizing the damage to healthy skin.

If a melanoma seems likely to spread, your doctor may perform a sentinel lymph node biopsy (SLNB) at the same time as they remove the original tumor. The SLNB procedure is used to determine whether cancer cells have travelled to one or more lymph nodes near the original cancer site.

Mohs Micrographic Surgery with MART-1 

Notably, Mount Sinai is the only academic medical center in New York City that uses a special stain called MART-1 during surgery to highlight melanoma cells under the microscope for immediate, same-day excision of early melanoma. This avoids sending you home and coming back to have the surgery about a week later, after the pathology test results come in.