Written and medically reviewed by: Assoc. Prof. Cengiz Dibekoğlu, MD, General SurgeryLast updated:
Soft Tissue Masses — Melanoma Surgery
Wide excision, the sentinel decision, and advanced disease
In Istanbul, melanoma surgery margins follow tumor thickness: often 0.5 cm, 1 cm, or 2 cm. The face, ear, or finger may need a narrower cut. It is not one number for every person.
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
This educational figure shows: The dashed ring is the extra margin removed after diagnosis. The centimeter is not the same for everyone; the ranges are in the text below. The small inset is an example sentinel node, not every patient’s map..
Key points
Why wide excision follows the diagnosis
A diagnostic biopsy names the lesion. It can leave microscopic extension around the scar. Wide local excision removes an additional clinical margin around that scar or any remaining lesion. This is not cosmetic mole removal. Oncologic clearance comes before the look of the scar. On the face, ear, or a digit, anatomy can force a narrower margin.
How the margin is planned
The margin is the extra skin taken around the biopsy scar after the diagnosis. How wide it is comes from the thickness on the pathology report (Breslow). A thicker melanoma usually means a wider margin is discussed. A common example from the European guideline (ESMO) is below. On the face, ear, finger, or sole, that measurement is often narrower. It is not the same cut for everyone.
- Only in the top layer of skin (in situ): 0.5 cm
- Thickness of 2 mm or less: 1 cm
- Thicker than 2 mm: 2 cm
Who is considered for a sentinel-node biopsy
Sentinel biopsy is not routine for thin pT1a melanoma without ulceration — for example, thinner than 0.8 mm and not ulcerated. ESMO recommends discussing it for pT1b disease: thickness of 0.8 to 1.0 mm, or thinner than 0.8 mm with ulceration. Thicker melanoma and added risk features such as lymphovascular invasion are decided with probability, the site, lymphatic mapping, and your preference. NCCN uses a similar risk frame; exact cutoffs can shift between guideline versions.
- Key note inside
What a positive sentinel node means
Microscopic involvement changes stage and can open a conversation about systemic therapy. Completion lymph-node dissection is not standard for every positive node. Surveillance ultrasound, medical oncology, and the tumor board sit at the same table.
Advanced disease and the team
When disease has spread, or when risk is high, immunotherapy, BRAF/MEK targeted therapy, and other systemic options are planned by medical oncology. Surgery can still have a role for selected metastases. That choice belongs to the tumor board. This page does not list drug doses or sequences.
Related pages
Moles and ABCDE →
The start of the path: a mole and a suspicious spot.
Diagnosis and Breslow →
Biopsy, thickness, and the sentinel-node idea.
Surgical oncology →
How oncologic surgery is approached in this practice.
Tumor board →
Dermatology, surgery, pathology, and medical oncology plan together.
International patients →
How to share records for a remote review.
Contact and appointments →
Write for an exam or a second opinion.
Frequently asked questions
Why is a wide excision done after melanoma is diagnosed?
The biopsy names the lesion. Wide excision aims to clear microscopic extension around it with a margin matched to that person. The margin is not a cosmetic margin.
If the sentinel node is positive, are all the nodes in that area removed right away?
No. A positive sentinel node does not automatically mean completion dissection. Current practice weighs ultrasound, systemic therapy, and a multidisciplinary plan together.
How wide is the margin in melanoma surgery?
It is chosen from the thickness on the pathology report. A common example is 0.5 cm if the melanoma is only in the top layer, 1 cm if thickness is 2 mm or less, and 2 cm if it is thicker. The face, ear, finger, or sole can force a narrower margin.
More chapters in this hub
Lipoma
Benign fatty masses — when to observe or excise
Skin Cysts
Epidermoid and pilar cysts — inflammation, infection, and excision
General Diagnosis
Lipoma and skin cysts — exam, ultrasound, MRI
General Treatment
Lipoma and skin cysts — observation and excision
Moles and Melanoma
Ordinary moles, common myths, and why change matters
Mole Diagnosis
Biopsy, Breslow thickness, and the sentinel node
Liposarcoma
Deep fatty malignancy — not a lipoma
Liposarcoma Diagnosis
MRI, biopsy, and tumor board
Liposarcoma Treatment
Wide excision, radiotherapy, and surveillance
Retroperitoneal Masses
Deep abdominal tumors — imaging and resection
Appointment / info
Evidence
Scientific sources
Show sources · 3NCCN, ESMO, and AAD framing for diagnostic biopsy, Breslow thickness, wide-excision margin ranges, and sentinel-node decisions in cutaneous melanoma. Ranges are adapted to the person and the site. A positive sentinel node is not automatic completion dissection.
Evidence
Scientific sources
- 1. NCCN Clinical Practice Guidelines in Oncology: Cutaneous MelanomaNational Comprehensive Cancer Network (NCCN) · Current versionOpen source →
- 2. Cutaneous melanoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-upEuropean Society for Medical Oncology (ESMO) · 2024 · DOI: 10.1016/j.annonc.2024.11.006Open source →
- 3. AAD — melanoma: signs, diagnosis, and treatment (patient education)American Academy of Dermatology (AAD) · Patient resource libraryOpen source →
Last reviewed: 21 August 2026. Links go to publisher pages.
This page is for education. It is not medical advice and does not replace a visit with your physician.
Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · Last medically reviewed: August 2026 · English patient-education chapter.