Types of Surgery

Stanford offers several types of surgery for melanoma. You may need one or more types depending on your individual case:

• For certain early melanomas on the face, a surgical technique called Mohs micrographic surgery may be used to remove melanoma cells one layer at a time. This type of surgery can be used for melanoma involving the very top layer of the skin, called melanoma in situ, and it allows the dermatology surgeon to look at the tissue under the microscope during the surgical procedure to ensure that the melanoma is completely gone.
• For thinner melanomas confined to the top layers of the skin, the dermatology surgeon may do a wide local excision.
• For melanoma that is thicker, a surgical oncologist generally performs the wide local excision at the same time that the sentinel lymph node biopsy is done. This surgery is performed in the operating room under general anesthesia. The doctor removes one or more small lymph nodes (about the size of an almond), which are examined by the dermatopathologists under a microscope for any melanoma.

Sentinel lymph node biopsies are usually done when the initial skin biopsy shows that the melanoma is 1 millimeter or more in thickness. Most melanomas are thinner than 1 millimeter.