4.2.2 Surgery

The definitive treatment of a primary melanoma involves an adequate margin of skin and subcutaneous fat. For a melanoma in situ, this is 5–10 mm. For an invasive melanoma, the margins of 10 mm or 20 mm will be considered depending on its thickness and specific type of melanoma (Cancer Council Australia Melanoma Guidelines Working Party 2019).

Surgery in a primary care or dermatology centre

Surgery under local anaesthetic with direct primary closure for excision biopsy and selected re-excision for in situ and early-stage melanomas can be undertaken in the primacy care setting by a dermatologist or a general practitioner with adequate training and experience.

Surgery by a specialist team

Surgery for all other excisions (including sentinel lymph node biopsy and regional lymphadenectomy) should be undertaken by a surgeon with adequate training and experience.

Resection of regional and distant metastatic melanoma may be appropriate in selected cases.

Timeframe for starting treatment

Surgery in a primary care setting should occur within two weeks of the decision that it is necessary.

Training and experience required of the surgeon

Fellow of the Royal Australian College of Surgeons, or equivalent, with adequate training and experience that enables institutional credentialing and agreed scope of practice in melanoma (ACSQHC 2015).

Documented evidence of the surgeon’s training and experience, including their specific (sub-specialty) experience with melanoma and procedures to be undertaken, should be available.

Health service characteristics

To provide safe and quality care for patients having more advanced surgery, health services should have these features:

  • critical care support
  • 24-hour medical staff availability
  • 24-hour operating room access and intensive care unit
  • diagnostic imaging
  • pathology
  • nuclear medicine imaging