To remove any cancer remaining after the biopsy. The procedure is called wide local excision.

The surgeon removes the rest of the tumor, including the biopsy site, as well as a surgical margin,( a surrounding area of normal-appearing skin), and the underlying subcutaneous tissue, to make certain the whole tumor has been removed.

Margins are taken all the way around the primary tumor. As an example, a 1 cm margin can be approximated by drawing a line that is 1 cm away from the site of the biopsy all the way around.

The width of the margin taken depends upon the thickness of the primary tumor.

Most surgeons today follow the guidelines adopted and recommended by the National Institutes of Health and the World Health Organization Melanoma Program.

• Stage IA - 1 cm margin - about 3/8 inch - for tumors that have a Breslow depth of 1 millimeter or less

• Stage IB - 2 cm margin - about 3/4 inch - for tumors with a depth between 1.1 mm and 3.99 mm.

Recent advances in surgery allow surgeons to take narrower margins than before, so a much greater amount of normal skin is preserved. However skin grafting may sometimes be necessary to cover the wound.

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Sentinel Lymph Node Biopsy

(SLNB)

Sentinel lymph node biopsy is most accurate when it is performed before wide local excision, the surgery to remove the tumor and the surrounding skin.

Recommended for patients with 

• Stage I tumors equal to or greater than than 1.0 mm
• Ulcerated tumors of any thickness
• Positive margins
• Lymphovascular invasion (seeing cancer cells In the lymphatic channels or blood vessels
• The presence of mitosis in young adults (rate at which cells divide) 

Purpose 

• Determine whether any cancer cells have spread to the sentinel node, the first lymph node to receive drainage from the primary tumor, and the site where melanomas commonly spread to first. 

• Further treatment will depend on whether the lymph node biopsy is positive.