Treatment for early melanoma

Surgery (wide local excision)

Surgery is the most common treatment for melanoma that is found early (stages 0–2 or localised melanoma). If found early, 90% of melanomas can be cured with surgery alone. If the risk of the melanoma spreading is high or it has spread to nearby lymph nodes or tissues (stage 3 or regional melanoma), treatment may also include removing lymph nodes and additional (adjuvant) treatments. Your doctor may suggest you have drug treatment before surgery (neoadjuvant treatment).

Surgery is the most common treatment for melanoma that is found early (stages 0–2 or localised melanoma). If found early, 90% of melanomas can be cured with surgery alone. If the risk of the melanoma spreading is high or it has spread to nearby lymph nodes or tissues (stage 3 or regional melanoma), treatment may also include removing lymph nodes and additional (adjuvant) treatments. Your doctor may suggest you have drug treatment before surgery (neoadjuvant treatment).

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.

Repairing 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.

What to expect after surgery

Most people recover quickly after a wide local excision to remove a melanoma, but you will need to keep the wound clean.

Pain relief

The area around the wide local excision may feel tight and tender for a few days. Your doctor will prescribe pain medicine if necessary.

Wound care

Your treatment team will tell you how to keep the wound clean to prevent it from becoming infected. Occasionally, the original skin flap or graft doesn’t heal. In this case, you will need to either have a dressing on the wound for longer or have another procedure to create a new flap or graft.

Skin change

If you have a skin graft, the area that had skin removed may look red and raw immediately after the operation. Over a few weeks to months, this area will heal, and the redness will fade.

When to seek advice

Talk to your doctor if you have any unexpected bleeding, bruising, infection, scarring or numbness after surgery.

Recovery time

The time it takes to recover will vary depending on the thickness of the melanoma and how much surgery was required. Most people recover in 1–2 weeks. Ask your doctor how long to wait before returning to your usual exercise and activities.

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.

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).

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).

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 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.

For further information about immunotherapy, targeted therapy and radiation therapy, see Treatment for advanced melanoma, Targeted therapy and Immunotherapy.