The first step in treating melanoma is surgery. Today physicians are able to remove far less tissue, achieving the same survival benefits while leaving the patient with a much smaller scar. This type of surgery is called “resection.”
Thin melanomas are often removed in the physician’s office or as an outpatient procedure under local anesthesia.
If the melanoma is thicker, flaps can be made from skin near the tumor, or with grafts of skin taken from another part of the body, insuring a good cosmetic result.
Mohs surgery is the single most effective technique for removing basal cell and squamous cell carcinomas and is now proving an effective way to remove melanoma in situ (contained skin cancers). This surgery spares the greatest amount of healthy tissue while achieving a cure rate of 98 percent or higher.
The procedure allows the surgeon to remove one thin layer of tissue at a time, checking it under a microscope for the presence of cancer cells. If the margins are cancer-free, the surgery is completed. If not, more tissue is removed from the margin until the sample is clear of cancer.
Surgery is the only treatment necessary for in situ melanomas---those that are contained on the surface layer of the skin.
It can also delay the need for systemic treatment for patients whose cancer has spread to one area, or to a very limited degree. Finally, surgery can play an important role in eradicating any residual cancer in patients responding well to the therapies described below.