Melanoma surgery (wide local excision)
Surgery to remove a melanoma along with a margin of healthy skin around it, to reduce the chance of it coming back where it started.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Wide local excision removes a margin of healthy skin around where the melanoma was, to lower the chance of it returning at that site.
- How wide the margin is depends on how deep the melanoma was, and follows NICE guidance — not a one-size-fits-all rule.
- A sentinel lymph node biopsy may be offered to help with staging; it is about information, not a cure.
- Surgery cannot promise the cancer will never return, so ongoing follow-up and skin checks matter.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Removes a margin of skin around the melanoma to lower the chance of it returning at that site
Surgery to the skin alone is not enough if the melanoma has already spread widely; the specialist team may prioritise other treatments.
Keep the dressing dry and the wound supported. Some bruising, swelling and tightness is normal. Simple pain relief usually controls discomfort.
Clear results given by a named clinician, with the stage explained in plain terms.
Keep the dressing dry and the wound supported. Some bruising, swelling and tightness is normal. Simple pain relief...
Non-dissolvable stitches are usually removed around 7–14 days, depending on the site. Avoid stretching the wound...
The laboratory report on the margins (and any node) usually comes back within 1–2 weeks. Your team explains the...
The scar softens and fades over months. If you had lymph node surgery, you may be advised on reducing the risk of...
What is melanoma surgery (wide local excision)?
Melanoma is a serious form of skin cancer that can spread, so removing it properly matters. Most people have already had the suspicious mole or area removed once (an excision biopsy) to make the diagnosis. Wide local excision is a second, planned operation to remove more skin around where the melanoma was.
The surgeon takes a margin of healthy-looking skin all around and beneath the original site. The width of that margin depends on how deep the melanoma was (its Breslow thickness) and follows national guidelines, because removing enough tissue lowers the chance of the melanoma returning at the same spot.
Some people are also offered a sentinel lymph node biopsy at the same time. This checks the first lymph node the area drains to, to see whether melanoma cells have started to travel. It helps with staging and planning, rather than being a treatment in itself.
Surgery treats the melanoma at the skin. It cannot guarantee the cancer will never come back or appear elsewhere, which is why follow-up and skin checks are an important part of melanoma care.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Wide local excision vs sentinel lymph node biopsy
| Wide local excision | Sentinel lymph node biopsy | |
|---|---|---|
| Purpose | Remove melanoma with a clear margin | Check if melanoma has reached nodes |
| What it treats | The skin where melanoma was | It is a staging test, not a treatment |
| Who | Almost everyone with melanoma | Offered for selected (often thicker) melanomas |
| Result affects | Local recurrence risk | Staging and further treatment options |
Your skin-cancer team will explain whether a sentinel lymph node biopsy is appropriate for you and what it would and would not tell you.
Preparing for your surgery
- Make sure you understand your diagnosis, the planned margin, and whether a sentinel lymph node biopsy is being offered.
- Ask how the wound will be closed (stitches, flap or graft) and what scar to expect.
- Tell the team about blood-thinning medicines and supplements, as some increase bleeding.
- Mention diabetes, steroid use or anything that affects healing.
- Stop smoking if you can, especially if a graft or flap is planned, as it reduces healing.
- Arrange a lift home and time off, particularly if you are having lymph node surgery or a general anaesthetic.
- Ask when and how you will get your results and who to contact afterwards.
What happens
Wide local excision is often done under local anaesthetic, with the skin numbed by injection. The surgeon removes more tissue around the original melanoma site, using a margin based on the melanoma's depth, and closes the wound with stitches. The tissue is sent to the laboratory.
If you are having a sentinel lymph node biopsy, a tracer and blue dye are used beforehand to find the first draining node. This part is often done under general anaesthetic, and the node is removed through a separate small cut and examined under the microscope.
If the gap is large, the surgeon may use a flap or graft to close it. Larger operations, awkward sites, or combined node surgery may mean a general anaesthetic and a longer day in hospital. Your team will explain the plan for you.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Surgery to the skin alone is not enough if the melanoma has already spread widely; the specialist team may prioritise other treatments.
- A sentinel lymph node biopsy is not recommended for very thin, low-risk melanomas where it would not change management.
- Very frail patients may be offered a less extensive approach after discussion of risks and benefits.
- Wide local excision should follow a confirmed diagnosis, not replace the initial diagnostic biopsy.
Delay surgery if…
- There is active infection at or near the surgical site.
- Blood-thinning medicines need adjusting and this has not been arranged.
- Diabetes or another condition affecting healing is poorly controlled.
- You are unwell, or you cannot arrange the aftercare that node surgery, a graft or a flap would need.
Alternatives to discuss
- There is no true alternative to removing the melanoma, but the margin and whether to do a node biopsy are decisions to discuss.
- For advanced disease, drug treatments (immunotherapy or targeted therapy) and radiotherapy may be part of the plan, decided by the team.
- Clinical trials may be available for some stages of melanoma.
- A specialist skin-cancer multidisciplinary team (MDT) should guide the overall plan.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Removes a margin of skin around the melanoma to lower the chance of it returning at that site
- The tissue is examined under a microscope to confirm the margins
- A sentinel lymph node biopsy, where appropriate, gives important staging information
- Helps the specialist team plan whether any further treatment or surveillance is needed
- Provides clarity on the stage of the melanoma
Risks & complications
- Bruising, swelling and soreness around the wound
- A scar, which may be longer than expected because of the margin removed
- Tightness or pulling near the wound, especially over joints
- Temporary numbness around the wound
- Wound infection needing antibiotics
- A graft or flap that partly fails to heal
- A collection of fluid (seroma) or bleeding under the wound
- Wound edges separating or delayed healing
- Lasting numbness from small nerves being cut
- Lymph node surgery causing longer-term swelling of a limb (lymphoedema)
- Damage to a larger nerve causing weakness or persistent numbness
- The melanoma returning at the site, in the nodes, or elsewhere despite surgery
The biggest uncertainty with melanoma is not the wound itself but whether the cancer has spread, which surgery alone cannot rule out. The width of the margin follows guidelines based on depth, not on removing as much as possible. If a sentinel lymph node biopsy is offered, ask what a positive or negative result would actually change for you. For sites like the lower leg or face, ask how the wound will be closed and what scar to expect.
Published figures to discuss
Outcomes after melanoma surgery depend mainly on the original depth and stage, not on the operation alone. Margins follow NICE guidance by stage rather than removing as much skin as possible. Recurrence and survival figures are population averages and cannot predict an individual's outcome; staging information helps the team estimate risk and plan follow-up.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Excision margin — stage 0 (in situ) melanoma | A clinical margin of at least 0.5 cm (NICE NG14) | Margins are measured around the biopsy scar and the original melanoma edge. | NICE NG14 — Melanoma: assessment and managementnice.org.ukSource-linked context |
| Excision margin — stage I melanoma | A clinical margin of 1 cm (NICE NG14) | A 1 cm margin may also be used for stage II if 2 cm would cause unacceptable disfigurement or morbidity. | NICE NG14 — Melanoma: assessment and managementnice.org.ukSource-linked context |
| Excision margin — stage II melanoma | A clinical margin of 2 cm (NICE NG14) | The exact margin is a clinical decision balancing clearance against the site and closure. | NICE NG14 — Melanoma: assessment and managementnice.org.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from wide local excision is usually straightforward — a healing wound and some tightness — but it depends on where it is, how much was removed, and whether you also had lymph node surgery or a graft or flap.
- A tender, firm scar that gradually softens and fades
- Tightness near the wound, particularly over a joint, that eases as skin stretches
- Numbness or odd sensation around the wound
- Mild swelling or bruising in the early days
- A wait of a week or two for the full laboratory result
Aftercare
- Follow your wound-care instructions and keep the dressing dry until told otherwise.
- Take simple pain relief such as paracetamol if needed.
- Avoid activity that pulls on the wound, especially across a joint, in the early days.
- If you had a graft, flap or node surgery, follow the specific advice you are given.
- If you had lymph node surgery, follow any advice on protecting the limb and reducing swelling.
- Protect the healing scar from the sun.
- Attend follow-up to get your results, remove stitches and discuss the plan.
- Learn how to check your own skin and lymph node areas.
- Wound-care instructions understood
- Date booked for stitch removal and results
- Simple pain relief at home
- Help and time off arranged, especially after node surgery
- Sun protection for the scar
- Advice noted on checking your skin and nodes
- Clinic contact number saved for problems
Scars and how they heal
Wide local excision leaves a scar that is usually longer than the original mole, because a margin of skin is removed and the wound is often closed as a straight line. Over joints or on the lower leg, healing can be slower and a graft or flap may be needed, leaving a larger scar and, with a graft, a second wound where the skin was taken from. Scars are tender and pink at first and fade over months. Ask your surgeon what to expect for your site.
⚠ Get urgent help if…
- Increasing redness, heat, swelling or pus around the wound (infection)
- Spreading redness with fever or feeling unwell
- Bleeding that does not stop with gentle pressure
- A graft or flap turning dark, dusky or very pale
- A tense, painful swelling under the wound
- Sudden or increasing swelling of the limb after node surgery
- A new lump near the scar, in the nearby lymph nodes, or elsewhere
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the melanoma has been removed with clear margins on the laboratory report, the wound heals, and — if a sentinel node was taken — you have clearer staging information. Wide local excision lowers the risk of the melanoma coming back at the same site, but it cannot prove the cancer has not spread, and it cannot guarantee that melanoma will never return or appear elsewhere.
Your stage, the depth of the melanoma and the node result guide whether you simply have skin surveillance or are offered further treatment. Decisions are usually made with a specialist skin-cancer multidisciplinary team.
Removing a melanoma with adequate margins greatly reduces the chance of it returning at that site, but melanoma can still recur locally, in lymph nodes or elsewhere, sometimes years later. The risk depends mainly on the original depth and stage. Because anyone who has had a melanoma is at higher risk of another, lifelong sun protection, skin self-checks and the follow-up your team arranges are all important.
Combining with other procedures
Wide local excision is often combined with a sentinel lymph node biopsy in the same operation for selected melanomas, and with a flap or graft if the wound cannot be closed directly. Depending on the stage, the specialist team may discuss additional treatments such as further node surgery, drug therapy or radiotherapy — these are planned separately, not as part of a standard wide local excision.
Follow-up & long-term care
You will usually get the full laboratory results within a week or two, at a wound-check or clinic appointment. After that, melanoma follow-up depends on the stage: it can range from skin self-checks with advice to regular clinic reviews and scans over several years. You should be shown how to check your own skin and lymph node areas and told what changes to report.
- Lifelong sun protection: cover up, use high-factor sunscreen and avoid sunbeds
- Regular skin self-checks for new or changing moles
- Check lymph node areas if advised, especially after node surgery
- Attend scheduled melanoma follow-up appointments and scans
- Report any new lump, skin change or symptom promptly
Revision and secondary surgery reality
- If the laboratory finds melanoma at the margin, further surgery is usually needed to achieve a clear edge.
- A positive sentinel lymph node may lead to further surgery, drug treatment or closer surveillance, decided by the team.
- A graft or flap that does not fully take may need redressing, time, or a further small procedure.
- Scars over joints or on the lower leg can sometimes need revision once the area is healed and clear.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear results given by a named clinician, with the stage explained in plain terms.
- A defined follow-up plan appropriate to the stage, including skin and node checks.
- Teaching on how to examine your own skin and lymph nodes and what to report.
- Advice on sun protection and reducing the risk of further melanomas.
- Access to a specialist team and a named contact for concerns.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The size and site of the melanoma and how wide a margin is needed
- Whether a sentinel lymph node biopsy is done at the same time
- Whether the wound is closed directly or needs a flap or skin graft
- Local versus general anaesthetic and theatre or facility fees
- Laboratory (histopathology) fees, including node analysis
- Follow-up appointments, scans and any further surgery or treatment guided by the stage
- The surgeon's fee and what operation it covers
- Whether sentinel lymph node biopsy is included or charged separately
- Laboratory (histology) fees for the skin and any node
- Reconstruction (flap or graft) costs if needed
- Anaesthetic fees if a general anaesthetic is used
- Follow-up appointments and surveillance arrangements
- What happens, and what it costs, if further surgery or treatment is recommended
On the NHS? Melanoma is routinely treated on the NHS once diagnosed, with care guided by NICE and a specialist team; private care may be used for speed or choice but follows the same approach.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that surgery cannot rule out spread or guarantee cure.
- Offering or declining a sentinel lymph node biopsy without explaining what the result would change.
- Not discussing the margin, scar, or the possibility of a graft or flap before surgery.
- No clear plan for who gives the results and what the stage means.
- Treating melanoma without a specialist multidisciplinary team involved.
Marketing red flags
- Any claim that surgery 'cures' melanoma or removes all risk of recurrence.
- Offering definitive melanoma surgery without histology or an MDT.
- Promising 'scarless' or minimal-scar removal regardless of margin.
- Downplaying the need for staging, follow-up or skin checks.
- Pressure to decide quickly without time to ask questions.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- What margin are you removing, and what does my melanoma's depth (Breslow thickness) mean?
- Should I have a sentinel lymph node biopsy, and what would a positive or negative result change?
- How will the wound be closed, and what scar should I expect?
- What stage is my melanoma, and what follow-up or further treatment might I need?
- What is my risk of it coming back, and how should I check my own skin and nodes?
- Will my case be discussed by a skin-cancer multidisciplinary team?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Why do I need a second operation if the mole was already removed?
What is a sentinel lymph node biopsy and do I need one?
Will I be awake during the surgery?
Does surgery cure melanoma?
Can I have this on the NHS?
How big will the scar be?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG14 — Melanoma: assessment and management Melanoma Focus — Wide local excision Cancer Research UK — Surgery to remove melanoma Cancer Research UK — Follow up after melanoma Surgical margins and SLNB indications in melanoma (PubMed) Sentinel lymph node biopsy for melanoma (PMC)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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