Treatment of Stage I Melanoma

Stage I malignant melanoma is cancer in the outer layer of the skin (epidermis) and/or the upper part of the inner layer of skin (dermis), with a thickness of less than 1 millimeter, and no spread to the lymph nodes.

Stage I melanoma is treated with surgical removal of the tumor along with some normal tissue around the tumor. The normal tissue is then examined under a microscope to be sure it is free of melanoma cells. For this stage of melanoma, the biopsy usually also serves as the treatment—a single procedure combines removal of the tumor with the biopsy.

At one time, a very wide area of normal skin was removed along with the primary melanoma in stage I disease. This led to disfigurement and often required skin grafting. Most surgeons now try to remove a narrower area of normal skin. However, if the melanoma has a thickness of more than 1 millimeter, a wider surgical area (margin) must be removed to reduce the risk of recurrence.

Most surgeons recommend a surgical margin of 2 centimeters (about 1 inch) surrounding the entire cancer for melanomas that are thicker than 1 millimeter. Skin grafting is necessary in approximately 10 percent of these patients. Research has shown that surgical margins wider than 2 centimeters are no more effective than narrower margins in preventing cancer recurrence.