Surgical excision is the definitive treatment for melanoma and for the majority of soft tissue tumours and suspicious skin lesions. Achieving the correct excision margin — removing the tumour with an adequate width of surrounding normal tissue — is the single most important technical goal of the operation and directly influences the risk of local recurrence.

At Breast & Surgical Oncology at The Poche Centre, lesion excision is performed by Prof Andrew Spillane, a nationally recognised surgical oncologist with extensive subspecialty experience in the excision of melanoma, soft tissue tumours, and complex skin lesions across all anatomical sites.

Melanoma Excision

Initial Excision and Diagnosis

When a suspicious pigmented or non-pigmented skin lesion is identified, the first step is diagnostic excision — complete removal of the lesion with a narrow 2 mm margin for histopathological analysis. This provides the pathologist with the intact lesion needed to confirm the diagnosis and, if melanoma is confirmed, determine the Breslow thickness (depth of invasion), mitotic rate, ulceration, and other features that define the stage and guide further management.

Diagnostic excision is a straightforward outpatient procedure performed under local anaesthetic. It should not be performed as a shave or punch biopsy for lesions suspicious for melanoma, as these techniques do not provide the full depth of tissue needed for accurate staging.

Wide Local Excision

Once a diagnosis of melanoma is confirmed, wide local excision (WLE) is performed to remove the biopsy site and the surrounding skin and subcutaneous tissue with a margin width determined by the Breslow thickness of the tumour. Current Australian and international guidelines recommend the following excision margins.

For melanoma in situ, a margin of 5 mm. For melanomas up to 1 mm Breslow thickness, a 1 cm margin. For melanomas 1 to 2 mm thickness, a 1 to 2 cm margin. For melanomas greater than 2 mm thickness, a 2 cm margin.

Wide local excision is performed under local or general anaesthetic depending on the size and location of the lesion and the complexity of the wound closure required. The excised specimen is sent for complete pathological analysis to confirm that the margins are clear on all sides.

Wound Closure and Reconstruction

After wide local excision, the resulting defect is closed using the most appropriate technique for the size and location of the wound and the surrounding tissue.

Primary closure — direct suturing of the wound edges — is used for smaller defects in locations where there is sufficient skin laxity to allow tension-free closure. This produces a linear scar and is the simplest and most common approach for smaller melanomas on the trunk and limbs.

Local flaps — where primary closure is not possible without undue tension or distortion, a local tissue flap rearranges adjacent skin and subcutaneous tissue to close the defect. Local flaps are particularly useful for lesions on the face, scalp, hands, and feet where skin laxity is limited and the functional and cosmetic stakes are higher.

Skin grafts — for larger defects where local tissue is insufficient, a skin graft harvested from a donor site (commonly the thigh or upper arm) is used to resurface the wound. Split-thickness skin grafts are used for larger wounds; full-thickness grafts are preferred for smaller defects on cosmetically or functionally sensitive areas such as the face.

The goal in every case is to achieve a tension-free closure that allows primary healing, preserves function, and produces the best achievable cosmetic result for the anatomical site.

Soft Tissue Tumour Excision

Soft tissue tumours encompass a broad spectrum of lesions arising from the connective tissues of the body — fat, muscle, fibrous tissue, nerves, and blood vessels. They range from entirely benign lesions such as lipomas and fibromas through to malignant soft tissue sarcomas, which are rare but clinically important tumours requiring specialist surgical management.

Benign Soft Tissue Lesions

Common benign soft tissue lesions requiring excision include lipomas (benign tumours of fat tissue), sebaceous and epidermoid cysts, dermatofibromas, neurofibromas, ganglion cysts, and other subcutaneous lumps that are causing symptoms, growing, or that the patient wishes to have removed for cosmetic or reassurance reasons.
Excision of benign soft tissue lesions is generally a straightforward outpatient procedure under local anaesthetic. All excised tissue is sent for pathological analysis as a standard step, as the clinical and imaging appearance of a lesion does not always predict the pathological diagnosis with certainty.

Soft Tissue Sarcomas and Complex Lesions

Soft tissue sarcomas are rare malignant tumours arising from the connective tissues. They most commonly present as a painless, gradually enlarging deep-seated mass, most often in the thigh, buttock, or retroperitoneum. Any soft tissue mass that is larger than 5 cm, deep to the fascia, growing, or painful should be assessed by a specialist surgical oncologist before any biopsy or excision is attempted.

The management of soft tissue sarcoma requires specialist expertise. Inadvertent incomplete excision of a sarcoma — performing a shell-out or simple excision without adequate margins at the initial operation — significantly worsens outcomes and complicates subsequent definitive surgery. All patients with a suspected soft tissue sarcoma are discussed at a specialist sarcoma multidisciplinary team meeting before any surgical intervention.

Surgical excision of soft tissue sarcoma requires wide negative margins and, depending on the tumour size, location, and histological type, is often combined with pre-operative or post-operative radiotherapy. Reconstructive procedures — including local and free flaps — may be required to achieve closure after wide excision of larger tumours.

Pre-Operative Assessment

Before excision, appropriate assessment is performed depending on the nature of the lesion.

For melanoma, staging investigations — including PET-CT or CT scan — are arranged for tumours with higher-risk features (generally Breslow thickness greater than 1 mm, ulceration, or high mitotic rate) to assess for regional and distant spread before definitive surgery.

For soft tissue lesions, MRI is the preferred imaging modality for characterising size, depth, and relationship to surrounding structures before excision. CT scan and PET-CT are used for staging when malignancy is suspected or confirmed.

Core needle biopsy under imaging guidance is recommended for larger or deep-seated soft tissue lesions before excision to obtain a pre-operative tissue diagnosis, which guides surgical planning and the need for neoadjuvant treatment.

Recovery

Recovery from lesion excision depends on the size and location of the procedure and the complexity of the wound closure. Simple excisions under local anaesthetic are day procedures with rapid return to normal activity. Larger excisions requiring flap reconstruction or skin grafting under general anaesthetic involve a short hospital stay and a longer recovery period, with wound care and physiotherapy as required.

All patients are followed up after surgery to review the wound, discuss pathology results, and plan any further management including sentinel node biopsy, staging investigations, adjuvant treatment, or surveillance.

Booking an Appointment

If you have a suspicious skin lesion, a confirmed melanoma, or a soft tissue lump that requires specialist assessment or excision, a referral from your GP or dermatologist to our practice is the appropriate next step.

This page is intended as a general guide only and does not replace personalised medical advice. The management of melanoma and soft tissue tumours requires individualised specialist assessment and should always be discussed with your surgeon.