Medical Oncologist
CION Cancer Clinics
Wide excision for melanoma | CION Cancer Clinics
A wide excision for melanoma is a second operation that removes the biopsy scar together with a measured rim of skin around it. The width of that rim, 1 cm for thin melanomas and 2 cm for thicker ones, is set by how deep the melanoma grew, not by how big the mole looked. A sentinel lymph node check is often done at the same time. This page explains why and what happens. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Why do I need a second operation if the mole is already gone?
- What do the words on a melanoma report mean?
- How wide is the margin for each thickness?
- What happens during a wide excision for melanoma?
- How does the site of the melanoma change the operation?
- Four things families tell us about melanoma surgery, and what is true
- Who is this operation not right for, and what this page cannot tell you
- Common questions about wide excision for melanoma
The short answer
Why do I need a second operation if the mole is already gone?
Because the first operation was a test, and this one is the treatment. The mole was removed with a tiny edge so the laboratory could say what it was. Now that it is known to be melanoma, a wide excision takes out the scar and a measured rim of skin around it, called the margin, so that any cancer cells nearby come out too.
What sets the size of the margin
One number on your biopsy report: the Breslow thickness, which is how deep the melanoma grew, measured in millimetres. Thin melanomas need a 1 cm rim. Thicker ones need 2 cm. Melanoma in situ, which sits only in the top layer of skin, needs less. The margin is not set by how big the mole looked.
What else may happen at the same time
For melanomas above a certain thickness, your surgeon may suggest a sentinel lymph node biopsy during the same anaesthetic. The lymph nodes are small glands that drain the skin, and the sentinel node is the first one the area drains to. Checking it tells the team whether the melanoma has started to travel. It is a staging test, not a treatment.
Bring the biopsy report to every appointment. The Breslow figure is what every decision starts from.On your report
What do the words on a melanoma report mean?
- Breslow thickness
- The depth of the melanoma in millimetres, from the top of the skin to the deepest cancer cell. The single most important figure on the report.
- Ulceration
- The surface of the melanoma had broken down under the microscope. It raises the stage and can lower the thickness at which a node check is offered.
- Melanoma in situ
- Cancer cells confined to the top layer of skin, with no growth downward. It still needs a wide excision, but a smaller one.
- Mitotic rate
- How many cells were caught dividing. A marker of how actively the melanoma was growing.
- Sentinel node
- The first lymph gland the skin drains to. If it is clear, the others almost always are too.
- Margins
- On the biopsy report, the tiny edge from the first removal. On the excision report, the planned rim, measured after the tissue has shrunk.
Not sure whether this applies to you?
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How wide is the margin for each thickness?
These are the guideline widths most teams work from. Your surgeon may adjust them on the face, the ear or a finger.
Breslow thickness
Planned margin of skin around the scar
In situ (top layer only)
0.5 cm to 1 cm
Up to 1 mm
1 cm
1 mm to 2 mm
1 cm to 2 cm, depending on the site
Thicker than 2 mm
2 cm
Thicker than 1 mm, or thinner with ulceration
A sentinel node biopsy is usually discussed as well
On the day
What happens during a wide excision for melanoma?
Marking up
The surgeon measures the planned margin out from the edge of the biopsy scar with a ruler and draws it on the skin, then draws the oval that will actually be cut so the wound closes flat.
Finding the sentinel node, if planned
A tiny amount of tracer is injected around the scar beforehand. During the operation the surgeon follows it to the first gland in the groin, armpit or neck and removes that gland through a small cut.
Removing the skin
The oval of skin and the fat beneath it are removed in one piece, down to the sheet covering the muscle. The piece is marked so the laboratory knows which edge is which.
Closing
Most wounds on the trunk, arm or thigh close with stitches. On the shin, scalp, foot or face a skin graft or a flap of nearby skin is often needed, and your surgeon will have told you this beforehand.
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Where it sits matters
How does the site of the melanoma change the operation?
Back, chest, thigh, upper arm
Loose skin, so even a 2 cm margin usually closes edge to edge. A local or general anaesthetic, home the same day or the next.
Lower leg and foot
Tight skin and slow healing. A skin graft is common, taken from the thigh, and you may be asked to keep the leg up and rest it for a while so the graft takes.
Expect
- A second wound where the graft came from
- Limited walking at first
Face, ear and scalp
The guideline margin may not be possible without harming the eye, nose or ear. The surgeon may plan a narrower rim with closer checking of the edges, and a flap of nearby skin to hide the scar in a natural line.
Fingers, toes and under a nail
There is no spare tissue. Melanoma here sometimes needs removal of the fingertip or the last joint. This is discussed openly beforehand, with what it means for grip and walking.
Ask to speak to a hand or foot specialist if this applies to you.Commonly believed
Four things families tell us about melanoma surgery, and what is true
"The mole was small, so it cannot be serious."
Melanoma is judged by depth, not width. A spot the size of a grain of rice can have grown deeper than a large flat patch. The Breslow figure on the report is the honest measure.
"The biopsy already got it all, so the second cut is optional."
The biopsy margin is usually a millimetre or two. The guideline margin for melanoma is ten to twenty times that. Skipping the wide excision leaves the skin around the scar unchecked, and that is where melanoma most often comes back.
"The sentinel node biopsy is the same as removing all the glands."
It is one gland, through a small cut, to find out whether spread has begun. Removing all the glands in an area is a different, larger operation and is no longer routine.
"A clear margin means I am finished with melanoma."
It means that spot has been dealt with. Melanoma can appear as a new spot elsewhere, and people who have had one are more likely to get another. Skin checks continue for years, and your team will set the schedule.
Being straight with you
Who is this operation not right for, and what this page cannot tell you
A wide excision is the standard treatment for a melanoma that is confined to the skin. It is not the whole answer when the melanoma has already spread to lymph glands or beyond, when scans show disease elsewhere, or when the person is too unwell for even a local anaesthetic procedure. Then the plan is built around drug treatment, and the skin operation may or may not still be part of it.
What you should hear before agreeing
Your surgeon should tell you the Breslow thickness, the planned margin in centimetres, whether a sentinel node biopsy is being suggested and why, how the wound will be closed, and what the scar and any graft will mean for your work and movement. If the plan is a narrower margin than the table above, ask why. There is usually a good reason.
What this page cannot tell you
It cannot tell you your stage, your outlook, or whether you need drug treatment after surgery. Those depend on the depth, the node result and any scans, read together by a team.
If you have the report but no appointment yet, call the helpline and someone will go through it with you.Questions we are asked
Common questions about wide excision for melanoma
How soon after the biopsy should the wide excision happen?
Usually within a few weeks, once the report is final and any staging tests are done. A short wait to plan properly, or to arrange a sentinel node biopsy in the same sitting, is normal. If you have been waiting for months without a date, chase it.
Will I be asleep for it?
A wide excision alone on the trunk or a limb is often done under local anaesthetic. If a sentinel node biopsy is planned, or a graft or flap is needed, a general anaesthetic is usual. The anaesthetist will decide with you.
What is the tracer injection for?
It is a small dose of a mildly radioactive tracer, sometimes with a blue dye, injected around the scar so the surgeon can find the sentinel gland. It does not treat anything. The blue dye can colour your urine for a while, which is expected.
What if the sentinel node has melanoma in it?
The stage goes up, and the team will discuss scans and possibly drug treatment to lower the chance of the melanoma returning. Removing all the remaining glands in that area is no longer automatic. Instead, the area is usually watched closely with ultrasound scans.
Will I need chemotherapy or radiotherapy afterwards?
Chemotherapy is rarely used for melanoma now. For higher-stage disease, immunotherapy or targeted tablets may be offered after surgery, decided on the node result and the depth. For a thin melanoma with a clear node, surgery alone is usually the whole treatment.
Can I have the wide excision on my face without a big scar?
The scar cannot be avoided, but it can be planned. On the face the surgeon may use a slightly narrower margin with careful edge checking, and close the wound with a flap that hides the line in a natural crease. Ask to see the planned lines drawn before you agree.
How long until I can go back to work?
For a simple excision closed with stitches on the trunk or arm, many people are back at a desk within days. A graft on the leg, or a sentinel node biopsy in the groin, means longer, with the leg kept up and no heavy work until the team clears it.
Is melanoma surgery covered by Aarogyasri or insurance?
Cancer surgery, including the sentinel node biopsy, is generally covered as part of an approved treatment plan. Aarogyasri, CGHS, ECHS and EHS are accepted at CION, and most cashless insurers are empanelled. Call the helpline with your card details and we will check your cover.
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Dr. C. Raghavendra Reddy
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- NICE — Melanoma: assessment and management (NG14)
- National Cancer Institute — Melanoma Treatment (PDQ) - Patient Version
- Cancer Research UK — Surgery for melanoma skin cancer
- American Cancer Society — Surgery for Melanoma Skin Cancer
- NHS — Melanoma skin cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
How Wide Is 'Wide'? Margins by Cancer TypeEvery cancer type's margin in one tableSkin Grafts: Donor Site and HealingIf the leg or foot wound needs a graftWide Excision on the Face: Cosmetic OutcomeHow the scar is planned on the faceFollow-Up and Skin Surveillance After ExcisionWhat the check-ups involve and for how longImmunotherapy guideThe drug treatment sometimes offered after melanoma surgery
Talk to us
Just been told the mole was melanoma?
Send us the biopsy report or call the helpline. A surgical oncologist will explain the Breslow figure, the margin being planned and whether a node check applies to you. One helpline serves every CION centre.