1. Surgery: a cornerstone of treatment

Surgery is the foundation of treatment for most melanomas detected at early stages. Its goal is to remove the tumor with a margin of healthy skin to ensure complete elimination of cancer cells.

How is surgery performed?

The standard procedure is a wide local excision. This means that, under local or general anesthesia depending on the case, the surgeon outlines an area around the melanoma, marking a safety margin, and removes the tumor along with a rim of surrounding healthy tissue. The size of the margin depends on the depth and extent of the tumor and is determined by international clinical guidelines.

In areas where the surgical margin is extensive or the location requires it (for example, the face, scalp, hands, or feet), reconstructive procedures are often needed after the melanoma is removed. These may include skin grafts (tissue taken from another area of the body) or flaps (segments of skin and underlying tissue moved to cover the defect).

These techniques aim to achieve proper healing, improve appearance, and preserve function in the treated area. Many patients require these reconstructive procedures to restore form and function after melanoma surgery.

Sentinel lymph node detection and biopsy

In melanomas of certain thicknesses or with high-risk features, it is recommended to assess whether the cancer has begun to spread to the lymph nodes. For this purpose, a sentinel lymph node biopsy is performed.

This procedure involves locating the first lymph node to which lymph drains from the tumor area (the “sentinel node”). Before surgery, a radioactive tracer and/or blue dye is injected around the melanoma scar. These substances travel through the lymphatic vessels and allow the surgeon to identify the sentinel node visually and with special instruments during the operation. Once detected, the node is removed and analyzed by the pathologist to determine whether it contains tumor cells.

If the sentinel node is negative (no cancer cells), additional lymph node surgery is usually not needed. If it is positive, the need to remove more lymph nodes may be considered, along with additional treatments.

Lymphadenectomy

In situations where melanoma in the lymph nodes is confirmed, removal of multiple lymph nodes in the affected region may be indicated.

Metastasis surgery

When melanoma has spread to other organs, surgery to remove specific lesions may be considered whenever feasible and beneficial for the person.

2. Immunotherapy

Immunotherapy stimulates the body’s own immune system to attack cancer cells. It is mainly used for advanced or metastatic melanoma. The most commonly used medications are immune checkpoint inhibitors (such as pembrolizumab, nivolumab). It is indicated for patients with advanced disease, recurrence, or when surgery is not possible.

3. Targeted therapy

Targeted therapy uses drugs that act on specific genetic alterations in tumor cells, such as the BRAF mutation. It is indicated for patients whose melanoma carries these mutations, especially in advanced stages.

4. Chemotherapy

Chemotherapy uses medications to destroy cancer cells. It is used less frequently today due to the effectiveness of other treatments, but it may be considered when there is no response to immunotherapy or targeted therapy.

5. Radiation therapy

Radiation therapy uses high-energy rays to destroy malignant cells. It is reserved for special situations, such as inoperable melanoma, brain metastases, or to relieve symptoms.