Skin & hair

Wide Local Excision — Removing the Margin Around Melanoma

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Once a biopsy has diagnosed melanoma, a wide local excision removes it again with a healthy margin — the step that actually clears the cancer from the skin. What to expect depends on the melanoma's depth: the margin, whether the lymph nodes are sampled at the same time, how it is closed, and how long the results take. Here is the procedure, start to finish.

Last updated: July 2026

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What is a wide local excision for melanoma?

A wide local excision is the standard surgery to treat a melanoma that has already been diagnosed on a biopsy. The first biopsy — ideally one that removes the whole spot at full thickness so the depth can be measured — confirms the diagnosis but usually leaves microscopic melanoma cells behind at the edges 4. The wide local excision goes back and removes the biopsy scar along with a rim, or margin, of normal-looking skin all the way around it and down beneath it.

The reason for the margin is that melanoma can extend a short distance past what the eye can see; taking a measured border of healthy tissue is what clears it 1. For most invasive melanomas this is the definitive treatment for the skin itself, and it is one part of what happens after a melanoma diagnosis.

How the surgeon decides how much to remove

The width of the margin is not arbitrary and it is not the same for everyone — it is set mainly by how deeply the melanoma grew into the skin, a measurement called Breslow depth taken from the biopsy 2. Thinner melanomas need a narrower margin; thicker ones need a wider one.

In broad terms, the guideline-recommended clinical margins run from roughly half a centimeter to a centimeter for the earliest, non-invasive melanoma in situ, up to about two centimeters for thicker invasive tumors 1. The margin is measured out from the visible edge of the lesion or scar, which is why even a small melanoma can leave a surgical wound noticeably larger than the original spot. If you want to understand the number a surgeon quotes, the two things driving it are your Breslow depth and whether the melanoma was in situ or invasive.

What happens on the day of the excision

Most wide local excisions are outpatient procedures done under local anesthetic — an injection that numbs the area so you are awake but feel no pain, much like the biopsy did 3. The surgeon marks the planned margin around the scar, usually as an ellipse (a pointed oval) so the wound can be closed in a straight, flat line. The marked skin is removed down to the fat, and the tissue is sent to a pathology lab.

Smaller wounds are closed edge-to-edge with stitches. Larger ones, or those over areas with little spare skin such as the shin, nose, or scalp, may need a skin flap (nearby skin moved over to fill the gap) or a skin graft (a thin layer of skin taken from elsewhere). The procedure itself often takes under an hour, though this varies a good deal with the size and the type of closure.

Will the lymph nodes be checked too?

For melanomas above a certain thickness, the surgeon may recommend a sentinel node biopsy at the same time as the excision. The sentinel node is the first lymph node the area drains to; sampling it checks whether any melanoma cells have traveled there, which is a staging step rather than a treatment 1. It is generally offered once a melanoma is thick enough that the chance of spread is meaningful, and it is discussed in advance because it can change the anesthesia and add a second small incision near the nearest cluster of nodes 3.

For thin, early melanomas it is usually not needed. Whether it is recommended for you comes back, again, to the Breslow depth and other features on your pathology report.

Recovery and wound care after the excision

Recovery depends mostly on where the melanoma was and how the wound was closed. Expect stitches or staples, a dressing, and some soreness, bruising, and tightness around the site for the first week or two. Wounds on the legs, back, and areas that move or bear weight tend to heal more slowly and to pull more than those on flatter, more sheltered skin.

The surgical team usually gives specific instructions on keeping the wound clean and dry, when it is safe to shower, how to limit activity that stretches the incision, and when the stitches come out — often somewhere between one and three weeks depending on the body part. A permanent scar along the line of the excision is expected; it typically fades and flattens over months. It helps to plan for the wound rather than the original spot: because of the margin, the incision is longer than most people picture.

Getting your results: what clear margins mean

After surgery, the pathology lab examines the removed tissue and reports whether the surgical margins are clear — meaning no melanoma cells reach the cut edges — and confirms the tumor's depth and features. Clear margins are the goal and the usual result of a wide local excision. 1 If the report finds melanoma at or very near an edge, called a positive margin, a re-excision to remove a little more tissue is the standard next step.

Results usually take about one to two weeks. Because a melanoma raises the chance of a second skin cancer over time, ongoing skin surveillance — periodic full-skin checks — becomes part of follow-up, and early-stage melanoma that is fully excised carries a high five-year survival 5. If a sentinel node was sampled, its result, together with the excision pathology, sets the overall stage and any further treatment.

Why a wide excision and not Mohs surgery?

For most invasive melanoma, a wide local excision — not Mohs micrographic surgery — is the standard operation, because the margin is chosen from the tumor's measured depth and the removed tissue is examined comprehensively for staging 1. Mohs and staged excision have a defined role mainly for certain melanomas in situ on the face, especially the lentigo maligna type, where healthy tissue is scarce and the borders are hard to see.

If you are weighing mohs vs excision for a melanoma, it is a question for the surgeon, and the answer turns on the melanoma's type, thickness, and location rather than a general preference for one operation over the other.

Common questions

The excision itself is done under local anesthetic, so the area is numb and you should not feel pain during it, though you may feel pressure or tugging. Afterward, expect soreness, tightness, and bruising for a week or two, usually manageable with what the surgical team advises. Severe or worsening pain is a reason to call them rather than wait.

Longer than the original spot, because the surgeon removes a margin of healthy skin around it and closes the wound in a straight line. The exact length depends on the melanoma's thickness, its location, and how the wound is closed. Most scars fade and flatten over several months; areas that move or bear weight tend to heal more slowly.

The pathology report on the excised tissue — confirming the depth and whether the margins are clear — usually takes about one to two weeks. If a sentinel lymph node was also sampled, its result is combined with the excision findings to set the overall stage. Your surgeon's office arranges a visit or call to go through what the report means.

If melanoma cells reach or come very close to the cut edge, that is called a positive margin, and the standard next step is a re-excision — going back to remove a little more tissue and check the new edges. It is a routine part of making sure the cancer is fully cleared, not a sign that something went wrong.

Only for melanomas thick enough to justify a sentinel node biopsy, which samples the first lymph node the area drains to as a staging step. Thin, early melanomas usually do not need it. Whether it is recommended depends mainly on the Breslow depth and other features on your biopsy, and it is discussed with you before surgery.

For early, thin melanoma that is fully removed with clear margins, the excision is often the definitive treatment for the skin, and outcomes are very good. Thicker melanoma, or melanoma that has spread to lymph nodes or beyond, needs additional staging and treatment. Either way, ongoing skin checks continue afterward because of the raised chance of a second skin cancer.

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When to call after a melanoma excision

  • —Spreading redness, warmth, or swelling around the incision, pus draining from it, or a fever — signs of a wound infection
  • —Bleeding that soaks through the dressing and does not slow with gentle, steady pressure
  • —The wound edges opening up, or pain that is sharply increasing rather than steadily improving

Bleeding that will not stop with pressure, or a spreading infection with fever, warrants urgent care or an emergency room; otherwise call the surgical team's office line about wound concerns.

This article is general education about what a wide local excision involves, not surgical or medical advice for your case. Margin widths, whether a lymph node is sampled, and after-care all depend on your pathology and are decided with your own surgical team. Follow the specific instructions they give you over anything general here.

References

  1. 1.Swetter SM, Tsao H, Bichakjian CK, et al. (2019). Guidelines of care for the management of primary cutaneous melanoma. Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2018.08.055Wide local excision with clinical margins set by tumor thickness is the standard surgical treatment for primary cutaneous melanoma; sentinel lymph node biopsy is a staging step, and staged excision or Mohs has a role for facial lentigo maligna.
  2. 2.Gershenwald JE, Scolyer RA, Hess KR, et al. (2017). Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA: A Cancer Journal for Clinicians. doi:10.3322/caac.21409Tumor thickness (Breslow depth) is a primary driver of melanoma staging, and it guides how wide the excision margin and how extensive the workup should be.
  3. 3.National Cancer Institute (PDQ Adult Treatment Editorial Board) (2025). Melanoma Treatment (PDQ®)–Health Professional Version. NIH / National Cancer Institute. link ✓Standard melanoma treatment centers on surgical excision, with sentinel lymph node biopsy offered for staging in thicker tumors.
  4. 4.American Family Physician (2011). Shave and Punch Biopsy for Skin Lesions. American Family Physician. link ✓A suspected melanoma is sampled with a narrow full-thickness (excisional or saucerization) biopsy to preserve staging accuracy; this diagnostic biopsy precedes the definitive wide local excision.
  5. 5.National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER) Program (2025). Cancer Stat Facts: Melanoma of the Skin. NIH / National Cancer Institute (SEER). linkEarly, localized melanoma that is fully excised carries a high five-year relative survival, which falls once the cancer has spread regionally or distantly.

5 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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