Treatment for Melanoma

Treatment depends on various factors, including the following:

The site of the original lesion.
The stage of the cancer.
The patient's age and general health.

Treatment options include the following:

Surgery is performed at every stage to remove the melanoma cancer cells.
Melanoma that has spread to lymph nodes or additional nearby sites usually requires additional forms of treatment including chemotherapy, immunotherapy, and radiation therapy.
Advanced melanoma that has spread to distant sites often cannot be cured, although surgical removal of metastatic tumors may provide some benefit by easing pain, increasing the general quality of life, and lengthening survival. Patients should seek to enter clinical trials, studies that examine new immunotherapies (vaccines, cytokines), gene therapies, chemotherapy combinations, or other treatments.

Surgery

Surgery is the primary treatment for all stages of melanoma.

Removal of the Melanoma. Some or all of the melanoma is often been removed during the biopsy. If cancerous tissue still remains after a diagnosis of melanoma, a surgeon will cut away additional tissue from the surrounding area to remove any stray cancer cells.

Mohs micrographic surgery was developed to allow meticulous surgical removal of skin tissue. This procedure involves the following:

Very thin layers are removed one at time, with each layer examined immediately under a microscope.
When the layers are shown to be cancer free, the surgery is complete.

Because the doctor needs to be certain that all cancer cells are removed, in some cases the surgical area required is very wide and requires plastic surgical techniques. The amount of tissue removed depends on the size, depth, and degree of invasion:

Stage I lesions that are less than 1 millimeter deep require the smallest excisions, usually about one centimeter (2/5 inch) off each side and downward from the original lesion.
For melanomas 2 mm or more in thickness, a margin of 3 cm is important for reducing the risk of recurrence.
Thicker lesions require wider excisions.