Surgery

Excision surgery: the basics

Excision biopsy

Any skin lesion suspicious of melanoma should be completely excised with a 1 mm margin of normal surrounding skin and sent for detailed analysis by a histopathologist.

Wide excision

Guidelines differ, but a melanoma-in-situ and and invasive melanoma with a tumour thickness less than 1 mm should be excised with a 1 cm margin. Invasive melanoma greater than 1 mm in thickness should be excised with a 2 cm margin and certainly if the Breslow thickness is 2 mm or greater.

Recommended Excision Margins based on Breslow Thickness

Data from: The United Kingdom Melanoma Study Group and the British Association of Plastic Surgeons (MSG/BAPS) multi-centre randomised trial of surgical width of excision margin in patients with thick cutaneous malignant melanoma.

Breslow Thickness Margin Size
< 1 mm 1 cm
1-2 mm 2 cm
> 2 mm 3 cm

References

Thomas JM, Newton-Bishop, A’Hern et al, 2004. N Engl J Med 350: 757-766. A surgical excision margin width in high risk (thickness 2 mm) cutaneous malignant melanoma: A Randomised Trial of 1cm vs 3cm excision margin in 900 patients

Institute of Cancer Research: MSG/BAPS