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Nodular melanoma: two surgical sessions.
Surgery is the main treatment for nodular melanoma, involving a wide local excision to remove the tumor and a surrounding margin of healthy skin. For thicker or higher-risk melanomas, a sentinel lymph node biopsy may be performed simultaneously to check for cancer spread. More advanced cases may require additional surgeries, including a lymphadenectomy (removal of more lymph nodes) or internal organ surgery, often in combination with other treatments like immunotherapy or targeted therapy.

Primary surgery for nodular melanoma
Wide local excision: This is the main treatment, where the surgeon removes the melanoma and a margin of healthy skin around it to reduce the risk of recurrence.
The size of the margin depends on the melanoma’s thickness, location, and other characteristics.
This can be an outpatient procedure performed under local anesthesia.
The wound is typically closed with stitches, but a skin graft may be needed for larger removals.
Sentinel lymph node biopsy: If the melanoma is over 1 millimeter thick or considered high-risk, a sentinel lymph node biopsy is often recommended to see if the cancer has spread to nearby lymph nodes.
The “sentinel” nodes are identified and removed for testing.
If these nodes are cancer-free, no further lymph node surgery is needed.
This is typically done at the same time as the wide local excision.