What are the types of surgeries used to treat melanoma?

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PeterBeitschMD (Physician - Surgery - Surgical Oncology (Verified) ) - 03 / 03 / 2012

Melanoma surgery usually involves a wide excision around the melanoma itself (typically 1 cm in radial diameter for every 1 mm in melanoma depth) and a sentinel lymph node biopsy. The margins (edges) of the wide excision are examined under the microscope to make sure all the melanoma is gone. Sometimes, usually just for non-invasive or very thin facial melanomas, a procedure called Moh's surgery is performed to minimize the amount of uninvolved skin removed. Moh's surgery involves removing a small amount of skin around the skin cancer and examining it immediately under the microscope. If melanoma cells are seen, then a couple of more millimeters of skin is removed and examined. This process is continued until the entire extent of the melanoma is removed. The process takes many hours of laborious work and that is why is is only used in areas of cosmetic or functional concern (typically the face) where wider excisions would be more problematic..

If the sentinel node has a deposit of melanoma in it, the other lymph nodes in the same area are at risk of having melanoma in them. Standard therapy would be to remove the rest of the lymph nodes in that basin (axilla, groin, neck). The lymph nodes are not connected in a 'chain-like' fashion but more of a 'spider's web' so the surgeon cannot just remove the 'next' lymph node in the chain and if it's negative, stop there. There is a large multi-national trial ongoing that randomizes sentinel node positive patients to either the standard of care (complete lymph node basin removal) or to observation of the basin with ultrasound every 3 months.
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