Treatment

When it comes to the early stages of the disease, the future is bright. Most people with thin, localized melanomas are cured by appropriate surgery. Early detection still remains the best weapon in fighting skin cancer.

More treatments are available for more advanced disease. The cure rate continues to rise. Research has produced a greater understanding of melanoma, leading to the development of new drugs.

Surgical Excision: The first step in treatment is the removal of the melanoma, usually by surgical excision (cutting it out). Most surgical excisions, also called resections, are done in a doctor's office or as an outpatient procedure with local anesthesia. Scars are usually small and improve over time. Surgery is less extensive than in the past, so scars are smaller.

Discolorations and areas that are depressed or raised following the surgery can be concealed with cosmetics specially formulated to provide camouflage. If the melanoma is larger and requires more extensive surgery, a better cosmetic appearance can be obtained with flaps made from skin that is near the tumor, or with grafts of skin taken from another part of the body. For grafting, the skin is removed from areas that are normally or easily covered with clothing.

There is now a trend towards performing a sentinel lymph node biopsy and tumor removal at the same time.

Setting the Margins

In today's technique, much less of the normal skin around the tumor is removed. The borders of the entire area to be excised — both tumor and healthy skin — are known as the margins. Margins are much narrower than they ever were before. Most surgeons today are following the guidelines recommended by the National Institutes of Health (NIH) and the American Academy of Dermatology Task Force on Cutaneous Melanoma:

• When there is an in situ melanoma, the surgeon excises 0.5 centimeter of the normal skin surrounding the tumor and takes off the skin layers down to the fat.
• In removing a melanoma that is 1 mm or less in thickness, the margins of surrounding skin are extended to 1 cm, and the excision goes through all skin layers and down to the fascia.
• If the melanoma is equal to or greater than 2 mm in Breslow's thickness, a margin of 2–3 cm is taken.