(See Tests for Melanoma Skin Cancer for a description of this procedure.) If the sentinel lymph node does not contain cancer, then there is no need for a lymph node dissection because it’s unlikely the melanoma has spread to the lymph nodes. If the lymph nodes are not enlarged, a sentinel lymph node biopsy may be done, particularly if the melanoma is thicker than 1 mm. If the nearby lymph nodes are abnormally hard or large, and a fine needle aspiration (FNA) biopsy or excisional biopsy finds melanoma in a node or nodes, a lymph node dissection is usually done. Depending on the thickness and location of the melanoma, this may be done by physical exam, or by imaging tests (such as ultrasound or CT or PET scans) to look at nodes that are not near the body surface. Once the diagnosis of melanoma is made from the skin biopsy, the doctor will examine the lymph nodes near the melanoma. For example, if the melanoma is on a leg, the surgeon would remove the nodes in the groin region on that side of the body, which is where melanoma cells would most likely travel to first. In this operation, the surgeon removes all of the lymph nodes in the region near the primary melanoma tumor. In uncommon situations where the melanoma is on a finger or toe and has grown deeply, part or all of that digit might need to be amputated. This is a slow process, often taking several hours, but it means that more normal skin near the tumor can be saved, which can help the area look better after surgery. This is repeated until a layer shows no signs of cancer. If cancer cells are seen, the doctor removes another layer of skin. Each layer is then looked at with a microscope. In this procedure, the skin (including the melanoma) is removed in very thin layers. Mohs surgery is done by a specially trained dermatologist or surgeon. This type of surgery is used more often for some other types of skin cancer, but not all doctors agree on using it for melanoma. In some situations, Mohs surgery (also known as Mohs micrographic surgery, or MMS) might be an option. Smaller margins might increase the risk of the cancer coming back, so be sure to discuss the options with your doctor. For example, if the melanoma is on the face, the margins may be smaller to avoid large scars or other problems. The margins can also vary based on where the melanoma is on the body and other factors. Thicker tumors need larger margins (both at the edges and in the depth of the excision). The recommended margins vary depending on the thickness of the tumor. The margins are wider because the diagnosis is already known. Wide excision differs from an excisional biopsy. The removed sample is then viewed with a microscope to make sure that no cancer cells were left behind at the edges of the skin that was removed. The wound is usually stitched back together afterward. The site of the tumor is then cut out, along with a small amount of normal skin around the edges (called the margin). Local anesthesia is injected into the area to numb it before the excision. This fairly minor operation will cure most thin melanomas. When melanoma is diagnosed by skin biopsy, more surgery will probably be needed to help make sure the cancer has been removed (excised) completely. Surgery is the main treatment option for most melanomas, and usually cures early-stage melanomas.
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