Surgery for Melanoma

Surgery for Melanoma

Melanoma surgeon, Mary Sue Brady, speaking with fellow MSK colleague in their masks and scrubs before a procedure

Our melanoma surgeons, including Mary Sue Brady (shown here), provide compassionate care to people with all stages of the disease.

Surgery is often the best option to cure early-stage melanoma (melanoma that hasn’t spread to other areas of the body). It can also be used to treat more advanced disease. 

At MSK, our patients benefit from the expertise of highly trained surgeons who specialize in the disease. These experts are helping set the standards for melanoma care worldwide and are also leading researchers in the field.

Our melanoma surgeons place a strong emphasis on completely removing the cancer while preserving quality of life. Achieving better outcomes with less surgery is our goal. That’s what allows us to provide you with the best option for controlling the disease while being highly attentive to your life after treatment.

No two melanomas are alike. Our melanoma surgeons work closely with a sophisticated team of imaging specialists and dermatopathologists (pathologists who specialize in diagnosing skin cancer and other dermatologic conditions). This collaboration helps ensure that you get the most precise diagnosis possible so that we can plan the most-effective treatment.

Our multidisciplinary team also includes surgeons from many other specialties, such as plastic surgeons, head and neck surgeons, orbital surgeons, and dermatologic surgeons who are there to guide your care if and when you need them. We work closely with experts in immunotherapy and other drug therapies to provide additional treatments that can reduce the chances of the melanoma coming back.

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Wide Excision for Melanoma

Wide excision is the name of the procedure in which a melanoma is removed. The amount of tissue needed to remove a melanoma depends primarily on:

  • how thick the tumor is
  • where the tumor is located 
  • how removing the tumor might affect personal appearance

To make sure the melanoma has been completely removed, the surgeon will also take some normal tissue from around the tumor. This healthy tissue is called the margin.

Dermatologic Surgery Options for Early-Stage Melanoma

Some people with very early-stage disease may be able to have the melanoma removed during an office visit using local anesthetic. When appropriate, such procedures should be performed by a board-certified dermatologist with special fellowship training in dermatologic surgery.

MSK’s dermatologic surgeons are highly experienced in melanoma care. We work closely with a team of experts to determine the best approach for each person who comes to us with early-stage disease. We are skilled in all types of procedures, including specialized techniques to remove melanoma as well as scar rejuvenation approaches. We have extensive expertise in managing a rare type of facial melanoma called lentigo maligna melanoma. Learn more about dermatologic surgery.

Sentinel Lymph Node Biopsy for Melanoma

Sentinel lymph node biopsy is a procedure usually recommended for people whose melanoma is likely to spread (metastasize) to lymph nodes. Your doctor will be able to determine the likelihood of metastasis based on certain characteristics of the tumor.

Sentinel lymph node biopsy involves the removal of the first lymph node to which the cancer cells are most likely to spread. A pathologist then examines the lymph node under a microscope to see if cancer cells are present. The knowledge gained from a sentinel lymph node biopsy can help your care team understand how to plan any further treatment.

MSK’s melanoma surgeons have been performing sentinel lymph node biopsies for more than 25 years. We have extensive experience in doing this procedure. Over the years, our surgeons have made many refinements to improve the technique.

When melanoma is found in the sentinel node, additional surgery may be needed. However, research shows that immediate surgery to remove the other lymph nodes in the area is typically not needed. People with melanoma in the sentinel node who follow a watch-and-wait approach — with later surgery, if necessary — do as well as those who have other regional lymph nodes immediately removed. MSK’s melanoma surgeons have been leaders in this approach, which has saved thousands of people from a painful side effect of lymph node removal called lymphedema.

Surgery for Melanoma on the Face and Other Sensitive Areas of the Body

People with a large facial melanoma may benefit from the expertise of our head and neck surgeons and dermatologic surgeons. We have vast experience removing melanoma from this delicate area. We also have special expertise in removing melanoma from other challenging areas, such as the palms of the hands and the soles of the feet.

Some people may benefit from a special noninvasive imaging technique called reflectance confocal microscopy. Developed at MSK, this technology helps us map a tumor before surgery. We are then able to determine exactly how much tissue we need to remove. This approach allows us to minimize the amount of tissue we remove while ensuring that we remove the cancer completely. It is particularly useful for melanoma that has developed in a delicate area or that has vague borders that blend into normal skin.

Plastic and Reconstruction Surgery for Melanoma

For smaller melanomas, your surgeon will close the wound with dissolvable sutures or, in some cases, allow the wound to heal naturally. Other methods may include a skin graft, which uses your own skin to repair the site, or an allograft, in which tissue from a donor is used.

For larger tumors, a plastic surgeon may repair the affected area using reconstructive techniques.

Reconstructive surgery for melanoma often involves taking tissue from one area of the body and using it in the affected area. MSK’s plastic and reconstructive surgeons have extensive experience in caring for people with melanoma. Our goal is to give you the best cosmetic outcome possible by using the latest techniques available.

MSK’s plastic and reconstructive surgeons work closely with your melanoma surgeon to give you a coordinated, seamless experience. Reconstruction is often possible as part of the same procedure to remove the tumor. That way we can avoid the need for a separate operation.

Surgery for Metastatic Melanoma

Metastatic melanoma is cancer that has spread beyond its original location to other parts of the body. The outlook for people with metastatic melanoma has never been better, thanks in large part to advances in immunotherapy. For some people, however, immunotherapy produces only a partial or temporary response. One of the ways we may be able to improve that response, or achieve a complete response, is by adding surgery to the treatment plan.

Our multidisciplinary melanoma team reviews each person we care for to see if surgery might provide an added benefit after immunotherapy. This is one of the many ways that our team challenges itself to provide everyone who comes to us for care with the best possible outcome.