Melanoma diagnosis and treatment
The pathway for diagnosing melanoma, a serious skin cancer, and removing it surgically — starting with an urgent referral when a mole looks suspicious.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Melanoma is a serious skin cancer that can spread, so a suspicious or changing mole needs prompt assessment, not delay.
- Diagnosis is made by removing the whole mole and examining it under the microscope; results usually take around 2 weeks.
- Treatment is usually surgery — a wider excision, sometimes with a sentinel lymph node biopsy — and the operation will leave a scar.
- Use the ABCDE guide and see a GP urgently about any new, changing, odd-looking, itchy or bleeding mole; do not wait.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Removing the whole mole gives a definite diagnosis and measures how deep the melanoma is
A changing or suspicious mole should never simply be monitored privately as a cosmetic concern; it needs proper assessment and, usually, removal.
The wound is dressed and may be sore. You keep it clean and dry as instructed, and avoid stretching the area. A graft or flap site needs more careful rest.
A named contact, usually a clinical nurse specialist, for questions and worries.
The wound is dressed and may be sore. You keep it clean and dry as instructed, and avoid stretching the area. A...
Pathology results from a diagnostic excision usually come back. Stitches may be removed (or dissolve), and you...
Wounds from wider surgery, grafts or node biopsy continue to heal. Bruising and swelling settle. Heavy activity is...
Scars mature and fade gradually. Staging is completed and a follow-up and skin-surveillance plan is agreed. Any...
What is melanoma diagnosis and treatment?
Melanoma is a serious type of skin cancer that starts in the pigment-producing cells of the skin. Unlike most other skin cancers, it can spread to other parts of the body, so it is taken seriously and treated promptly.
Diagnosis usually starts when a mole or skin patch looks suspicious. A GP who is concerned should refer you urgently on a suspected-cancer pathway so a skin specialist (dermatologist) can examine it, often using a magnifier called a dermatoscope. The name and target of this pathway differ across the UK; in England, the Faster Diagnosis Standard aims for cancer to be confirmed or ruled out within 28 days of referral — this is not a guarantee of a first specialist appointment within 2 weeks. If melanoma is suspected, the whole mole is removed (an excision biopsy) and sent to a laboratory, where a specialist doctor (histopathologist) examines it.
If melanoma is confirmed, most people need a second, wider operation called a wide local excision to remove a margin of healthy skin and reduce the chance of it coming back. Depending on how deep the melanoma is, a sentinel lymph node biopsy may be offered at the same time to check whether cells have begun to spread.
This is a cancer pathway, not a cosmetic procedure. The aim is to remove the cancer fully and find out its stage. It should never be framed as a beauty treatment, and a suspicious changing mole should never be left to 'watch and wait'.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Diagnostic excision biopsy
The whole suspicious mole, with a narrow margin, is removed under local anaesthetic and sent to the lab. This is how melanoma is confirmed and its depth (Breslow thickness)...
Wide local excision
If melanoma is confirmed, a wider area of skin around the original site is removed to clear any remaining cells. How wide depends on the melanoma's thickness. This is the...
Sentinel lymph node biopsy
For some melanomas (often those of a certain thickness), the first lymph node the area drains to is identified and removed to check for spread. It is usually done at the same...
Skin graft or flap repair
Where a large area is removed, the wound may be closed with a skin graft (skin taken from elsewhere) or a flap, rather than stitched directly. This affects the scar and...
Preparing for your procedure
- See a GP urgently about any new or changing mole; ask specifically about an urgent suspected-cancer referral if melanoma is a concern.
- Use the ABCDE guide (Asymmetry, Border, Colour, Diameter over about 6mm, Evolving/changing) to describe what you have noticed.
- Bring photos showing how the mole has changed over time if you have them.
- Tell the team about all your medicines, especially blood thinners, and any allergies.
- Mention any personal or family history of melanoma or other skin cancers.
- Arrange time off and help at home if a larger operation or a graft is planned.
- Ask whether you will need a sentinel lymph node biopsy, as this changes the operation and anaesthetic.
What happens
First, a skin specialist examines the mole, often with a dermatoscope, and usually removes the whole lesion under local anaesthetic as an excision biopsy. The sample goes to the laboratory, where a histopathologist confirms whether it is melanoma and measures how deep it goes (the Breslow thickness). Results usually take about two weeks.
If melanoma is confirmed, you are told the diagnosis and the plan, which is reviewed by a specialist multidisciplinary team. Most people then have a wide local excision to remove more skin around the original site. If the melanoma is thick enough to warrant it, a sentinel lymph node biopsy may be done at the same time.
Depending on the size and site, the wound is stitched, or closed with a skin graft or flap. Further tests such as scans may be arranged if there is a risk the melanoma has spread, and these guide the overall stage and any additional treatment.
Is this procedure 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…
- A changing or suspicious mole should never simply be monitored privately as a cosmetic concern; it needs proper assessment and, usually, removal.
- Shave or partial removal that does not allow the full depth to be measured is generally the wrong approach for suspected melanoma.
- Cosmetic or laser 'mole removal' without histology is unsafe where melanoma is possible, because it can destroy the evidence needed to diagnose it.
- Surgery alone may not be enough if the melanoma has already spread, when a wider team and other treatments are needed.
Delay or rearrange if…
- Do not delay assessment of a suspicious mole — this pathway is urgent.
- Surgery may be timed around blood-thinning medicines, but the diagnosis itself should not wait.
- An active skin infection at the site may need treating before wider surgery.
- Pregnancy or other conditions may affect timing and anaesthetic choices and should be discussed.
- Practical delays should be minimised; ask the team what is safe.
Alternatives to discuss
- For confirmed melanoma there is no safe 'no treatment' option; the realistic choices are about the type and extent of surgery and additional treatment.
- Margins and whether to do a sentinel node biopsy can be discussed with the team.
- For more advanced disease, immunotherapy, targeted therapy or radiotherapy may be options alongside or instead of further surgery.
- The NHS urgent pathway is the standard route and is available to everyone.
- Clinical trials may be available for some patients and can be discussed with the team.
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.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Removing the whole mole gives a definite diagnosis and measures how deep the melanoma is
- Wide local excision aims to remove any remaining cancer cells and lower the risk of it returning at that site
- A sentinel lymph node biopsy can show whether the melanoma has begun to spread, which guides treatment
- Early diagnosis and surgery give the best chance of cure for thin melanomas
- Staging helps the team plan the right follow-up and any further treatment
Risks & complications
- A permanent scar at the excision site, sometimes larger after wide local excision
- Pain, bruising and swelling around the wound while it heals
- Needing a second, wider operation after the first diagnostic removal
- Waiting and anxiety while pathology results and staging are completed
- Wound infection, bleeding or delayed healing
- A skin graft or flap not fully taking, needing further care
- Numbness or altered sensation around the scar
- Lymph node biopsy causing swelling, fluid collection or, less often, longer-term swelling (lymphoedema)
- Melanoma found to be more advanced than expected, needing further treatment
- Recurrence at the site or elsewhere despite surgery
- Significant reaction to general anaesthetic where used
- Long-term lymphoedema after lymph node surgery
The most important point is that melanoma can spread, so the priorities are an accurate diagnosis and complete removal — not the size of the scar. Ask your team about the Breslow thickness, the planned excision margin, whether a sentinel lymph node biopsy is recommended for you, and what the follow-up plan will be. Never accept advice to simply watch a mole that is changing.
Published figures to discuss
Survival and recurrence figures vary widely with the melanoma's thickness and stage, so single numbers can mislead. The strongest figures are population survival statistics, which are encouraging for early disease but should not be read as a personal guarantee. Surgical complication rates depend on the size and site of surgery and whether lymph nodes are involved.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Five-year survival, stage 1 (earliest) melanoma | Around 100% (UK figures) | Earliest-stage melanoma has an excellent outlook, which is why prompt diagnosis matters; this is a population figure, not a personal promise. | NHS — Melanoma skin cancer: Diagnosisnhs.ukPublished figure |
| Long-term survival, all melanoma combined | Around 9 in 10 surviving 10 years or more (UK figures) | Outlook is worse for thicker or more advanced melanoma; figures depend heavily on stage. | Guide sourcesClinical context |
| Wider excision or lymph-node staging after diagnosis | Depends on Breslow thickness, ulceration and stage | Patients should understand that the first diagnostic excision may not be the final treatment. | Guide sourcesClinical context |
| Follow-up intensity | Stage-dependent | Early melanoma may need clinic follow-up and self-checking; higher-stage disease may involve imaging, oncology and immunotherapy discussions. | Guide sourcesClinical 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.
What happens afterwards
Recovery depends mainly on how much skin is removed and how the wound is closed. A small diagnostic excision heals quickly; a wide local excision, graft or lymph node biopsy takes longer, and the emotional side of a cancer diagnosis matters too.
- A tender, firm scar that softens and fades over months
- Bruising and swelling around the wound early on
- Tightness or numbness near the scar
- Tiredness and worry while waiting for results and staging
- Limited movement for a while if surgery was near a joint or a graft was used
Aftercare
- Follow the wound-care and dressing instructions you are given, and keep the area clean and dry.
- Avoid heavy lifting or stretching the wound, especially near a joint, until advised it is safe.
- Protect the healing scar from the sun and use high-factor sun protection long-term.
- Attend all follow-up appointments for results, staging and skin checks.
- Learn how to examine your own skin and lymph nodes, and report any new or changing lesions.
- Take pain relief as advised and watch the wound for signs of infection.
- Ask for and use any psychological or cancer-support services if you are struggling.
- Clear written wound-care and dressing instructions
- Date for results and the next appointment
- A named contact (often a clinical nurse specialist) and their number
- High-factor sunscreen and sun-protection plan
- Help at home arranged if a larger operation or graft is planned
- Information on self-examination and what changes to report
Scars and how they heal
Surgery to remove melanoma always leaves a scar — this is unavoidable, because the cancer and a margin of healthy skin must be taken out. A small diagnostic excision usually leaves a thin line. A wide local excision removes more tissue, so the scar is longer, and where a lot of skin is taken the wound may be closed with a skin graft or flap, which looks and feels different from the surrounding skin. Scars are red or firm at first and usually soften and fade over months, but they are permanent. The team places and closes wounds to heal as well as possible, but complete removal of the cancer is always the priority over the appearance of the scar.
⚠ Get urgent help if…
- Increasing redness, swelling, heat, throbbing or discharge from the wound (possible infection)
- Bleeding from the wound that does not stop with gentle pressure
- A graft or flap turning dark, very pale or coming away
- Fever or feeling generally unwell after surgery
- Increasing swelling of an arm or leg after lymph node surgery
- A new lump near the scar or in nearby lymph glands
- Any new, changing, bleeding or odd-looking mole anywhere on the skin
- Severe pain, breathlessness or a swollen, painful calf (seek urgent help)
Who to contact: your clinician, clinic or test provider 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 specialist gives you.
Results & realistic expectations
A good result means the melanoma has been completely removed with clear margins, the pathology and any node biopsy give a clear stage, and a sensible follow-up plan is in place. For thin, early melanomas treated promptly, the outlook is generally very good, with most people living well beyond five years.
However, no surgery can guarantee that melanoma will never come back, and results depend on the thickness and stage. That is why ongoing skin checks and follow-up matter, and why any new or changing lesion should be reported rather than ignored.
Outcomes depend heavily on how early the melanoma is found. Thin, early-stage melanomas have an excellent outlook, with around 9 in 10 people overall surviving their melanoma long term and almost everyone with the earliest-stage disease doing so. Thicker or more advanced melanomas carry a higher risk of return and need closer follow-up. Because you remain at higher risk of another melanoma, lifelong sun protection and skin awareness are important.
Related tests, treatments or support
Diagnosis and treatment are often staged together: the diagnostic excision first, then wide local excision with sentinel lymph node biopsy if indicated. Scans and blood tests may be combined to complete staging. For more advanced disease, surgery may be combined with immunotherapy, targeted drugs or radiotherapy, all coordinated by a specialist multidisciplinary team.
Follow-up & long-term care
After treatment you are usually followed up for a period that depends on the stage, with regular skin and lymph-node checks and advice on self-examination. A clinical nurse specialist often coordinates care. Any new or changing lesion, or a lump near the scar or lymph glands, should be reported promptly between appointments.
- Examine your own skin and lymph glands regularly and report changes promptly.
- Use high-factor sun protection and avoid sunburn and sunbeds for life.
- Attend scheduled follow-up appointments for the recommended period.
- Keep a record or photos of moles to help spot changes.
- Seek prompt review of any new, changing or symptomatic lesion.
Repeat, follow-on and what comes next
- A second, wider operation after the diagnostic excision is the norm, not a complication.
- Margins are sometimes found to be involved, occasionally needing further surgery.
- Recurrence at the site or elsewhere is possible and is why follow-up and skin surveillance continue.
- Reconstruction (graft or flap) may need its own revision or further care.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact, usually a clinical nurse specialist, for questions and worries.
- Clear results timelines, staging explanation and a written follow-up plan.
- Wound-care instructions and prompt review of any wound or graft problems.
- Teaching on skin and lymph-node self-examination and what to report.
- Access to psychological and cancer support, and lifelong sun-protection advice.
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 number of operations needed (diagnostic excision, then wider surgery)
- Whether a sentinel lymph node biopsy is required
- How the wound is closed (direct stitching, skin graft or flap)
- Anaesthetic type and whether any hospital stay is needed
- Laboratory (histopathology) reporting and any additional tests
- Staging scans and specialist multidisciplinary team review
- Follow-up appointments and any further treatment if the melanoma has spread
- The surgeon's fee and which operations are included
- Laboratory (histopathology) and any sentinel node biopsy costs
- Anaesthetic and facility or hospital-stay fees
- Cost of staging scans and multidisciplinary team review
- Follow-up appointments and skin-surveillance arrangements
- What happens, and what it costs, if wider surgery or further treatment is needed
- How urgent results and any complications are handled
On the NHS? Melanoma is diagnosed and treated on the NHS through an urgent suspected-cancer pathway (its name and target differ by UK nation; in England the Faster Diagnosis Standard aims for cancer to be confirmed or ruled out within 28 days of referral); private assessment may be used for speed, but treatment should always follow the same evidence-based, specialist-led pathway.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — 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
- Treating a suspicious mole as a cosmetic issue and not sending it for histology.
- Not explaining that a wider second operation is usually needed after diagnosis.
- Underplaying the scar, graft or lymph-node surgery and its effects.
- No clear plan for staging, follow-up or who to contact with worries.
- Implying surgery guarantees the melanoma will never return.
Marketing red flags
- 'Scarless' or 'lunchtime' mole removal for suspicious lesions
- Laser or cosmetic removal of moles without sending them to a laboratory
- Any suggestion to watch a changing mole rather than refer it urgently
- Framing melanoma surgery as a cosmetic or beauty service
- Promises of a guaranteed cure
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers 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 any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- How thick is the melanoma (Breslow thickness), and what stage does that suggest?
- What excision margin are you planning, and how will the wound be closed?
- Do you recommend a sentinel lymph node biopsy for me, and why or why not?
- Do I need any scans, and what is the plan if the melanoma has spread?
- What will my follow-up and skin-surveillance plan be, and for how long?
- Who is my named contact if I am worried between appointments?
- 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 specialist who carries out my procedure, 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 procedure 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
How quickly should a suspicious mole be seen?
Is melanoma treatment available on the NHS?
Why do I need a second, bigger operation?
Will I have a scar?
What is a sentinel lymph node biopsy for?
How long do results take?
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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: NHS — Melanoma skin cancer: Diagnosis NHS — Melanoma skin cancer: Symptoms Cancer Research UK — Sentinel lymph node biopsy for melanoma Cancer Research UK — Survival for melanoma skin cancer Cancer Research UK — Symptoms of melanoma (ABCDE) Royal Marsden — Skin cancer diagnosis (GP resources) NHS England — cancer waiting times guidance (Faster Diagnosis Standard)
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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