NCCN Guidelines for Patients® | Melanoma

36 NCCN Guidelines for Patients ® : Melanoma, 2018 4  Overview of melanoma treatments Surgery Part 4 describes the main treatments for melanoma. Knowing what a treatment is will help you understand your treatment options listed in the Treatment guide in Part 5. There is more than one treatment for melanoma. Not every person with melanoma will receive every treatment listed in this chapter. Surgery Surgery is an operation to remove or repair a body part. Generally, surgery is the main or primary (first) treatment for melanoma skin cancer. Thus, almost all patients with melanoma will have surgery after the skin biopsy. The goal of surgery is to remove all of the cancer from your body. For melanomas that are deemed by your doctor to have a low risk of spread, surgery to remove the primary tumor on the skin may be the only treatment needed. There are different types of surgery that may be used for melanoma. The two main types of surgery used are a wide excision and a lymph node dissection. Wide excision A wide excision is surgery that removes the entire melanoma tumor on the skin along with some normal-looking tissue around its edge. Even if the melanoma is removed on the initial diagnostic biopsy, a wider excision is performed to remove nearby lymphatic channels in the skin, where there could be additional tumor cells. See Figure 10 . The normal-looking tissue is called the surgical margin. The size of the surgical margin, measured in cm ( c enti m eters), depends mostly on the thickness of the tumor. See Guide 2. Depending on the size of the surgical margin and the location of the melanoma, a wide excision may be done using local anesthesia that is injected into the area to numb it before the surgery. Local anesthesia is medicine that results in a temporary loss of feeling in a small area of the body to prevent pain during the procedure. When wider margins are removed, or when wide excision is combined with lymph node surgery, general anesthesia is often needed. General anesthesia is medicine that causes a temporary loss of feeling and a complete loss of awareness that feels like a very deep sleep. For lentigo maligna melanoma, particularly on the face, different types of surgery may be recommended to very carefully examine the surgical margins. A pathologist will examine the removed tissue with a microscope to see if there is any cancer in the surgical margins. If the margins have cancer, you may need more surgery. A positive margin means there is cancer in the surgical margin. A negative margin means there is no cancer in the surgical margin. Guide 2. Surgical margins for melanoma Tumor thickness Surgical margin In situ 0.5–0.1 cm ≤1.0 mm 1.0 cm >1.0–2.0 mm 1.0–2.0 cm >2.0–4.0 mm 2.0 cm >4.0 mm 2.0 cm