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BASICS IN DERMATOLOGIC SURGERY
Standart two step surgical procedure.
Surgical procedure for cutaneous melanoma patients : no way to
Make a mistake.
A two-step surgical procedure for melanoma involves a first, diagnostic excision to remove the suspicious lesion with a small margin for testing, followed by a second, wide local excision (WLE) to remove more tissue if the first report confirms melanoma. The size of the second excision is determined by the melanoma’s thickness (Breslow thickness) and location to ensure all cancer cells are removed and to reduce the risk of recurrence.

Step 1: Diagnostic Excision
Your doctor first removes the suspicious mole or area of skin with a small margin (often about 2 mm) of normal skin.
This tissue is sent to a pathology lab to confirm if it is melanoma and to measure its thickness.
This may be performed by your family doctor or a referral to a specialist.
Step 2: Wide Local Excision (WLE)
If the pathology report confirms melanoma, a second surgery is scheduled.
The goal of the WLE is to remove a larger margin of healthy skin and tissue around the original scar to ensure all cancer cells are gone.
The size of this margin depends on the melanoma’s thickness and its location on the body. For example, a margin of 1–2 cm is common for invasive melanomas.
This procedure is often done under local anesthesia and may be referred to as re-excision.
Potential Considerations
One-step surgery: In some cases, high-frequency ultrasonography can measure the tumor’s thickness before surgery, allowing for a single-step procedure.
Sentinel lymph node biopsy: Depending on the melanoma’s characteristics, a sentinel lymph node biopsy may be performed at the same time as the wide local excision to check if the cancer has spread to nearby lymph nodes.
Reconstruction: The resulting wound from the WLE is typically stitched closed. If a large amount of tissue was removed, a skin graft or local flap may be needed to close the area.