Synopsis
Explain the sequence from diagnostic melanoma excision to stage-based wide local excision, select sentinel-node discussion using current NICE criteria, and design follow-up around recurrence risk, skin surveillance and patient support.
- Diagnostic excision removes the suspicious lesion completely with a narrow margin to establish melanoma diagnosis, Breslow depth, ulceration and pathological stage.
- Wide local excision is a second procedure around the biopsy scar; its clinical margin is determined by stage and includes the initial primary-lesion margin.
- NICE advises at least 0.5 cm for stage 0, 1 cm for stage I and 2 cm for stage II, using 1 cm if a 2 cm margin would cause unacceptable disfigurement or morbidity.
Key red flags
A new scar nodule, in-transit dermal lesion, firm regional node, persistent focal pain, neurological deficit, unexplained weight loss or respiratory symptoms after melanoma requires urgent specialist reassessment rather than waiting for routine follow-up.
A new dermal or subcutaneous nodule between the primary scar and draining nodal basin can represent lymphatic melanoma spread.
Investigation priorities
Provide Breslow thickness, ulceration, margins and adverse features before definitive planning.
Management branches
A completely sampled primary lesion is confirmed as stage 0, I or II melanoma.
- Review Breslow depth, ulceration, biopsy margins and stage in the specialist skin-cancer multidisciplinary team.
- Plan wide local excision around the histological scar using at least 0.5 cm for stage 0, 1 cm for stage I and 2 cm for stage II unless morbidity dictates the NICE alternative.