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 underlying subcutaneous tissue to make sure the whole tumor has been removed. 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 IIA & IIB - 2 cm margin - about .75 inch - for tumors between 1.1 mm and 3.99 mm in depth (Breslow Depth)

• Stage IIC - 2-4 cm margin - about .75 inch to 1.5 inch - for tumors greater than 4 mm; 2 cm margin - about .75 inch - for tumors between 1.1 mm and 3.99 mm in depth (Breslow depth)

Recent advances in surgery allow surgeons to take narrower margins than before, so a much greater amount of normal skin is preserved.

 For more information on Surgery click here

Sentinel Lymph Node Biopsy

(SLNB)

Sentinel lymph node biopsy is recommended for all Stage II tumors regardless of size.

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

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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.

Treatment given in addition to a primary cancer treatment is recommended following surgery for Stage IIB and Stage IIC melanoma. These are systemic therapies that go through the bloodstream to reach and affect cancer cells throughout the body.

• Interferon is a protein produced by normal cells to fight viral infections and disease.

• Interferon therapies have been shown to help the body's immune system fight disease more effectively.
• Studies indicate that low dose interferon alfa-2b, a manufactured form of interferon, consistently delays relapse in patients with later Stage II melanoma but does not extend overall survival. High dose interferon alfa-2b is the only adjuvant treatment to significantly prolong disease-free survival in patients with late Stage II Melanoma.

Treatment Side Effects

• Although there are well-documented benefits of treatment with interferon, the therapy is associated with side effects, and it lasts 12 months.

• Recently there has been some use of a shorter course of the therapy or the use of a long-acting, pegylated form of interferon. The results of these studies have not been strong enough to change the current practice.

  For more information on Immunotherapy click here

Clinical trials are research studies to evaluate new therapies and improve cancer care. These studies are responsible for most of the advances in cancer prevention, diagnosis, and treatment. If you have melanoma, you may be eligible to participate in a clinical trial.

Several experimental treatments are currently being tested in Clinical Trials:

• Experimental vaccines, GM-CSF, CTLA4-blocking antibodies, interleukins, and other therapies designed to boost the immune system to fight the return of melanoma
• Chemotherapy treatments

Except for chemotherapy, all of these treatments are designed to boost the immune system. These therapies have not yet been shown to extend overall survival in any randomized, controlled trials for any stage of melanoma, and in some cases may even worsen survival rates. Scientists are constantly working to improve the efficacy of these treatments