Procedures to Treat Melanoma

After an initial biopsy of a lesion on the skin that demonstrates melanoma, the following surgical options should be considered:

  • Wide excision: A surgical procedure to remove the cancerous tissue plus a margin of healthy skin surrounding it, which may require skin grafting. The size of the wide excision depends on the Breslow thickness (depth of invasion) seen on the initial narrow biopsy, as follows:

Breslow Thickness

Recommended Margin on Wide Excision (NCCN Guidelines)
In situ  0.5 cm
< 1mm 1.0 cm
1.01-2mm 1-2 cm
 > 2mm  2.0 cm

                                                                                        

  • Sentinel Lymph Node Biopsy (SLNB): A surgical procedure to determine if the initial lymph nodes draining from the primary melanoma have cancer cells within them. This procedure helps with staging and is of prognostic value. It often is performed concomitantly with the wide excision. The decision to perform this procedure is determined on a case by case basis. The role of this procedure in thin melanomas is less clear given the overall positive prognosis, and in certain studies the rate of the sentinel lymph node being involved is less than 10 percent. The value in deep melanomas that are 4mm in depth or greater is also unclear, but retrospective studies demonstrate that the presence or absence of sentinel lymph node involvement is an independent predictor of outcome in patients with deep melanomas

  • Completion Lymph Node Dissection: A surgical procedure to consider if the sentinel lymph node is involved.

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Melanoma and Skin Cancer Center
The Mount Sinai Hospital
One Gustave L. Levy Place
Box 1128
New York, NY 10029

Tel: 212-824-8698

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