Surgery has made great advances in the 1990s, and much less tissue is removed than was customary even a few years ago. Patients do just as well after the lesser surgery, which is easier to tolerate and produces a smaller scar. The surgical excision is also called resection, and the borders of the entire area excised are known as the margins. In most cases, the surgery for thin melanomas can be done in the doctor's office or as an out-patient procedure under local anesthesia. Wound healing takes one to two weeks, and most patients are advised to avoid heavy exercise during this time.
Scars are usually small and improve over time.
Discolorations and areas that are depressed or raised following the surgery can be concealed with cosmetics specially designed to provide camouflage. If the melanoma is larger and requires more extensive surgery, a better cosmetic appearance can be obtained with flaps made from skin that is near the tumor, or with grafts of skin taken from another part of the body. For grafting, the skin is removed from areas that are normally or easily covered with clothing. In the new approach to surgery, much less of the normal skin around the tumor is removed and the margins, therefore, are much narrower than they ever were before. In removing a melanoma, which is 1 mm or less in Breslow thickness, the margins of surrounding skin are extended to 1 cm, and the excision goes through all skin layers and down to the fascia.