{"id":26,"date":"2018-01-30T21:03:42","date_gmt":"2018-01-31T02:03:42","guid":{"rendered":"https:\/\/www.saintjohnscancer.org\/melanoma\/treatment\/wide-local-excision\/"},"modified":"2025-04-23T18:20:25","modified_gmt":"2025-04-23T22:20:25","slug":"wide-local-excision","status":"publish","type":"page","link":"https:\/\/www.saintjohnscancer.org\/melanoma\/treatment\/wide-local-excision\/","title":{"rendered":"Surgery (Wide Local Excision)"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":null,"protected":false},"author":2,"featured_media":0,"parent":22,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-26","page","type-page","status-publish","hentry"],"acf":{"layers":[{"acf_fc_layout":"layer_content_sidebar","layer_label":"","layer_headline":"","layer_intro":"","layer_content":"
\"SJCI-Research-Facility-2025\"
The Saint John’s Cancer Institute is a pioneer in melanoma and sentinel node research.<\/figcaption><\/figure>\n

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

At Saint John’s Health Center, we employ decades of research experience via the Saint John’s Cancer Institute, a pioneer in melanoma research since the 1990s.<\/p>\n

What is the Wide Local Excision Procedure?<\/h2>\n

\"Wide
Wide local excision removes additional tissue around the cancer site and reduces surgical appearance.<\/figcaption><\/figure>Wide local excision is a procedure that removes a rim of normal tissues around the lesion, 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.<\/p>\n

Current NCCN Recommendations for Wide Local Excision<\/h3>\n

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.<\/p>\n

The Breslow Thickness measurement is a crucial prognostic tool in melanoma surgery. It quantifies the depth of the melanoma from the top of the granular layer of the epidermis (or from the base of an ulcer if the surface is ulcerated) to the deepest point of tumor invasion. This measurement, recorded in millimeters, is the single most important factor in determining the prognosis for localized primary melanoma and guides surgical decisions, such as the extent of tissue removal during wide local excision.<\/p>\n\n\n\n\n\n\n\n
\n

Breslow Thickness<\/h3>\n<\/th>\n

\n

Margin<\/h3>\n<\/th>\n<\/tr>\n

Melanoma-in-situ<\/td>\n5 mm<\/td>\n<\/tr>\n
Breslow <1mm<\/td>\n1 cm<\/td>\n<\/tr>\n
Breslow 1.01-2mm<\/td>\n1-2 cm<\/td>\n<\/tr>\n
Breslow 2.01-4mm<\/td>\n2 cm<\/td>\n<\/tr>\n
Breslow >4mm<\/td>\n2 cm<\/td>\n<\/tr>\n<\/table>\n

Preparing for Surgery<\/h2>\n

While preparations for skin surgery, such as wide local excision for melanoma, are generally minimal, patients should consider several factors to ensure a smooth experience. It’s important to follow any preoperative instructions provided by the surgeon, which may include guidelines on fasting or medication adjustments. Patients should also arrange for transportation to and from the surgical facility, as they may not be able to drive post-procedure due to anesthesia effects. Additionally, wearing loose, comfortable clothing can help avoid irritation around the surgical site. Lastly, planning for post-surgery care, such as having over-the-counter pain medications and arranging for help with daily activities, can facilitate a quicker and more comfortable recovery. You may also receive specific instructions regarding your surgical case.<\/p>\n

Recovery from Wide Local Excision<\/h3>\n

Recovery is usually fairly quick. Depending on the location and size of the incision, most patients feel 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.<\/p>\n

How does Wide Local Excision differ from Moh’s Surgery?<\/h2>\n

Wide local excision involves removing the tumor along with a margin of surrounding healthy tissue. The size of the margin depends on the Breslow thickness of the melanoma. This procedure is typically quicker and performed on an outpatient basis. The excised tissue is sent to pathology for examination, and results are usually available within a few days.<\/p>\n

Mohs surgery, also known as Mohs micrographic surgery, is a specialized technique primarily used for basal cell carcinoma and squamous cell carcinoma, though it can be used for melanoma in certain cases. During Mohs surgery, the tumor is removed layer by layer, and each layer is examined under a microscope immediately. This process continues until no cancer cells are detected in the tissue. Mohs surgery is highly precise and conserves as much healthy tissue as possible, making it ideal for tumors in cosmetically or functionally critical areas, such as the face.<\/p>\n

\"Mohs
Mohs Surgery involves surgically removing thin layers of the skin, revealing the extent and location of the cancer.<\/figcaption><\/figure>Key Differences:<\/strong><\/p>\n