Wide Local Excision for Melanoma

A Wide Local Excision (WLE), sometimes described as a Wide Excision, is the most common surgical procedure used to remove melanoma. During this procedure, your surgeon will attempt to remove the entire melanoma lesion and a pre-determined margin of healthy-looking skin around all of its edges. For many patients with early-stage melanoma, a wide local excision is curative. 

What Happens During a Wide Local Excision:

During a Wide Local Excision, your surgeon will try to remove the entire melanoma tumor, along with a pre-determined margin of healthy-looking skin around its edges. The size of this margin is determined based on the thickness of your melanoma along with other characteristics of the tumor (such as ulceration). After removing the melanoma and the required margin, your surgeon will then suture the wound together. 

Wide Local Excision Melanoma2In some instances, your surgeon may use a skin graft to close the wound. During a skin graft your surgeon, or a plastic surgeon, will remove skin from a different area of your body and will use this skin to cover the area where your melanoma was. 

Depending on the scope of the surgery, it may be performed using only local anesthesia – to prevent pain – in your doctor’s office. If a more involved surgery is required, or if the surgeon will also be performing a Sentinel Lymph Node Dissection, it will be performed using general anesthesia, in an operating room. Talk to you doctor about what you should expect during the procedure.  

After the surgery, a pathologist will carefully examine the surgical margins using a microscope to determine if the surgeon successfully removed all traces of melanoma. If the pathologist detects melanoma in the surgical margins, you may need additional surgery.

Due to the relatively large margins required to safely excise, or remove, melanoma, your surgeon may remove more tissue than you expected. Talk to your surgeon about any questions or concerns. 

What are the Benefits of a Wide Local Excision?

The ultimate goal of a wide local excision is to remove the entire – or as much as possible – of a melanoma lesion, leaving only healthy tissue and cells behind. For early stage melanoma – stages 0-2 – a wide local excision is often curative.  

For more advanced melanomas, a wide local excision is used in combination with systemic melanoma treatments, such as immunotherapy or targeted therapy. In this use case, the surgery is used to remove the ‘bulk’ of the melanoma while the systemic treatments target any metastasis or residual melanoma cells throughout the body. 

When systemic treatments are given after the surgery, this is called adjuvant therapy. Adjuvant therapy is an additional treatment given after surgery to reduce the risk of recurrence. When the systemic treatments are started before surgery, this is called neoadjuvant therapy. In neoadjuvant therapy, the systemic treatments (immunotherapies or targeted therapies) are started before surgery, then the surgery is performed, and systemic treatments can continue after treatment. 

Surgery can also provide pain relief as it quickly removes bulky tumor tissues. This can be an important improvement in the quality of life, and reduction of pain, for the patient.

What are the Potential Risks of a Wide Local Excision?

No medical procedure, including a wide local excision, is without risk. Wide local excisions can increase your risk of infection, cause scarring at the surgical site, bleeding, and healing problems may occur. You also could have an allergic reaction to the anesthesia. In addition, like other surgical procedures, a wide local excision can cause short-term pain, swelling, and bruising at the surgical site. 

Following surgery, many patients do not fully understand the extent of scarring that occurs as a result of a wide local excision. Ask your doctor for additional information on what you should expect and how you can promote healing. 

If a wide local excision is recommended by your surgeon, they have determined that the benefits outweigh any risks of the procedure. Please speak to your surgeon about any specific concerns.

What Does Research Say About Wide Local Excisions?

Wide local excision is the cornerstone of melanoma surgical management of melanoma. It is included in the current NCCN clinical practice guidelines and has been safely used for decades. 

While Mohs Micrographic Surgery (Mohs Surgery) is selectively used to treat melanoma in situ (stage 0), wide local excision remains the only accepted surgical technique for all invasive melanomas.

Questions to Ask Your Doctor About a Wide Local Excision:

Remember, every individual's situation is unique, so feel free to ask any additional questions that come to mind. Your surgeon is there to provide you with the information and support you need to make informed decisions about your treatment. Below are some questions to consider asking your doctor: 

  1. What is a wide local excision, and why is it recommended for my melanoma? 
  2. How will the procedure be performed, and what can I expect during and after the surgery? 
  3. Will a sentinel lymph node biopsy be performed along with the wide local excision? If so, what does it involve and what are the potential outcomes?
  4. What are the potential risks and complications associated with a wide local excision? 
  5. How will the excision affect the appearance and function of the affected area? 
  6. Will I require any additional treatments after the surgery, such as immunotherapy, after the excision? 
  7. What is the expected recovery time, and when can I resume my normal activities? 
  8. Are there any specific precautions or lifestyle changes I should follow after the surgery? 
  9. What are the chances of the melanoma recurring after the wide local excision? 
  10. Are there any alternative treatment options available for my specific case? 
  11. Are there any specific factors or characteristics of my melanoma that may affect the prognosis or treatment options? 
  12. What are the long-term follow-up recommendations after the wide local excision?