Treatment Wide Local Excision

Wide Local Excision for Treatment of Melanoma

If melanoma is caught early, it is highly treatable. Surgery with wide local excision is the main treatment for early melanomas and may be used as part of the treatment approach for advanced melanomas.

Depending on the depth of the melanoma (or Breslow thickness), the margin of normal tissue surrounding the abnormal lesion varies. This is done after the diagnosis is made. This helps reduce the risk of the cancer returning at the primary site.

What to Expect

Wide local excision is a procedure that removes a rim of normal tissues around the lesion. This is called the margin. The size of the margin depends on the Breslow thickness of the melanoma and sometimes the location on the body. This procedure is well-tolerated and typically only requires over the counter pain medications like Tylenol or ibuprofen. The procedure is usually an outpatient procedure.

Current NCCN Recommendations for Wide Local Excision

After the primary tumor is removed, the skin area excision is closed with stitches or sometimes a skin graft is needed to cover the site. This can be done either in the clinic or in the operating room. The tissue removed is sent to pathology for examination and a report is usually complete in 5-7 days.

Breslow Thickness  Margin
Melanoma-in-situ  5 mm
Breslow <1mm  1 cm
Breslow 1.01-2mm  1-2 cm
Breslow 2.01-4mm  2 cm
Breslow >4mm   2 cm

Preparing for Surgery

This procedure requires no specific preparation. You will receive instructions regarding anesthesia requirements prior to your surgery.

Recovery

Recovery is usually fairly quick. Depending on the location and size of the incision, most patients are feeling well a few days after the surgery. Each surgery has different activity restrictions based on where the incision is. Your surgeon will give you specific postoperative instructions.

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Trevan Fischer MD

Trevan Fischer, M.D.

Assistant Professor of Surgical Oncology
Dr. Leland Foshag

Leland J. Foshag, M.D.

Professor of Surgical Oncology
Richard Essner, M.D. FACS - Director of Surgical Oncology

Richard Essner, M.D. FACS

Co-Director, The Borstein Family Foundation Melanoma Program at Saint John’s Cancer Institute
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