{"id":6870,"date":"2012-01-17T20:37:07","date_gmt":"2012-01-17T19:37:07","guid":{"rendered":"http:\/\/www.ilmelanoma.com\/"},"modified":"2026-10-17T11:34:53","modified_gmt":"2026-10-17T10:34:53","slug":"atlas-of-melanoma-surgery","status":"publish","type":"page","link":"https:\/\/www.ilmelanoma.com\/en\/melanoma\/melanoma-plastic-surgery\/atlas-of-melanoma-surgery\/","title":{"rendered":"Atlas of melanoma surgery"},"content":{"rendered":"<div class=\"im26-diagnosis-guide im26-plastic-guide\">\n<aside class=\"im26-dg-related im26-gandini\">\n<h2>The contribution of Dr Daniele Gandini<\/h2>\n<p>Original section by <strong>Dr Daniele Gandini<\/strong>, specialist in Plastic, Reconstructive and Aesthetic Surgery, Casa di Cura San Rossore, Pisa.<\/p>\n<p>Appointments: <a href=\"tel:+39050586217\">050586217<\/a> \u00b7 Switchboard: <a href=\"tel:+39050586111\">050586111<\/a> \u00b7 Mobile: <a href=\"tel:+393386053169\">3386053169<\/a>.<\/p>\n<p><a href=\"https:\/\/www.danielegandini.it\/\" rel=\"nofollow noopener\">Dr Gandini\u2019s website<\/a> \u00b7 <a href=\"https:\/\/www.danielegandini.it\/appuntamenti-visite.asp\" rel=\"nofollow noopener\">Appointment information<\/a><\/p>\n<p><small>The photograph, original attribution and contact details are retained. The 2026 editorial revision does not certify renewed approval of the text by Dr Gandini.<\/small><\/p>\n<\/aside>\n<p>Educational information, not a prescription. Decisions require specialist assessment; editorial source checking is not equivalent to clinical validation.<\/p>\n<nav class=\"im26-dg-toc\" aria-label=\"On this page\"><strong>On this page<\/strong><\/p>\n<ol>\n<li><a href=\"#plastic-leggere\">How to read this atlas<\/a><\/li>\n<li><a href=\"#plastic-escissione\">Excision: from historical operations to current planning<\/a><\/li>\n<li><a href=\"#plastic-lembo\">Local flap: planning and immediate appearance<\/a><\/li>\n<li><a href=\"#plastic-innesti\">Grafts and donor areas<\/a><\/li>\n<li><a href=\"#plastic-sentinella\">Sentinel lymph node localisation<\/a><\/li>\n<li><a href=\"#plastic-linfonodi\">Melanoma with clinically apparent nodal enlargement<\/a><\/li>\n<li><a href=\"#plastic-piede\">Extensive foot lesions and preserving function<\/a><\/li>\n<li><a href=\"#plastic-recidive\">Recurrence and symptom control<\/a><\/li>\n<li><a href=\"#plastic-complicanze\">Complications and new lesions near a scar<\/a><\/li>\n<\/ol>\n<\/nav>\n<aside class=\"im26-dg-related\"><a href=\"https:\/\/www.ilmelanoma.com\/en\/melanoma\/melanoma-plastic-surgery\/\">Read also: Plastic and reconstructive surgery for melanoma<\/a><\/aside>\n<section class=\"im26-dg-section\" id=\"plastic-leggere\">\n<h2>How to read this atlas<\/h2>\n<p>The atlas retains photographs from the original section curated by Dr Daniele Gandini. They document individual cases and different moments in care; they cannot establish a personal diagnosis, select a technique or predict an outcome. Captions have been editorially revised to prevent historical descriptions becoming universal recommendations.<\/p>\n<p>Photographs include lesions, wounds and operations that some readers may find distressing. Each group relates the archive description to current context. Where complete clinical information is unavailable, no stage, long-term outcome or definite cause of a complication is inferred. General clinical context is linked to the cited sources and the page on <a href=\"https:\/\/www.ilmelanoma.com\/en\/melanoma\/melanoma-plastic-surgery\/\">plastic and reconstructive surgery for melanoma<\/a>.<\/p>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39550033\/\">ESMO \u2014 Cutaneous melanoma: Clinical Practice Guideline (2024\/2025)<\/a>; <a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/melanoma\/treatment\/surgery\/surgery-remove-melanoma\">Cancer Research UK \u2014 Surgery to remove melanoma skin cancer<\/a>.<\/small><\/p>\n<\/section>\n<section class=\"im26-dg-section\" id=\"plastic-escissione\">\n<h2>Excision: from historical operations to current planning<\/h2>\n<p>The first two images illustrate outcomes after different excisions. The first was described in the archive as the result of a wide Olsen-type excision; the second shows a linear scar. They are not a controlled comparison and do not show that the second result is achievable in every situation.<\/p>\n<p>Today, excision extent is based on histological characteristics and guidelines, with attention to site and function. The priority is adequate cancer treatment while limiting unnecessary tissue loss. Highly extensive historical operations should not be presented as the routine model, but neither should they be replaced by a promise of invariably minimal scars.<\/p>\n<div class=\"im26-dg-gallery\">\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/1.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/1-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"1. Historical result of extensive excision, described in the archive as an Olsen-type operation.\"\/><\/a><figcaption>1. Historical result of extensive excision, described in the archive as an Olsen-type operation.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/2.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/2-300x237.jpg\" width=\"300\" height=\"237\" loading=\"lazy\" decoding=\"async\" alt=\"2. Example of a linear postoperative scar: an individual case outcome.\"\/><\/a><figcaption>2. Example of a linear postoperative scar: an individual case outcome.<\/figcaption><\/figure>\n<\/div>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39550033\/\">ESMO \u2014 Cutaneous melanoma: Clinical Practice Guideline (2024\/2025)<\/a>.<\/small><\/p>\n<\/section>\n<section class=\"im26-dg-section\" id=\"plastic-lembo\">\n<h2>Local flap: planning and immediate appearance<\/h2>\n<p>This sequence retains the design of a Limberg flap, tissue transfer and suturing. A flap uses tissue with a blood supply to cover a defect. Its design must respect anatomy, tension and neighbouring structures; reproducing the drawing on skin is not sufficient.<\/p>\n<p>The final photograph shows the immediate postoperative appearance, not the definitive scar. Healing, possible complications and scar maturation can change appearance over time. These images cannot guarantee absence of distortion, tension or a need for later revision.<\/p>\n<div class=\"im26-dg-gallery\">\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/3.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/3-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"3. Preoperative design of a local Limberg flap.\"\/><\/a><figcaption>3. Preoperative design of a local Limberg flap.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/1-1-300x225.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/1-1-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"4. Flap transfer and partial suturing: intraoperative photograph.\"\/><\/a><figcaption>4. Flap transfer and partial suturing: intraoperative photograph.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/2-1-300x225.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/2-1-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"5. Completed suturing immediately after surgery; this is not the final scar.\"\/><\/a><figcaption>5. Completed suturing immediately after surgery; this is not the final scar.<\/figcaption><\/figure>\n<\/div>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/melanoma\/treatment\/surgery\/surgery-remove-melanoma\">Cancer Research UK \u2014 Surgery to remove melanoma skin cancer<\/a>; <a href=\"https:\/\/www.cuh.nhs.uk\/patient-information\/care-of-your-scar\/\">Cambridge University Hospitals \u2014 Care of your scar<\/a>.<\/small><\/p>\n<\/section>\n<section class=\"im26-dg-section\" id=\"plastic-innesti\">\n<h2>Grafts and donor areas<\/h2>\n<p>A graft may be an option when direct closure is unsuitable. This group combines an outcome illustrated in the archive with two examples of donor sites. Interpretation requires distinguishing full-thickness and split-thickness grafts: tissue characteristics and donor-site management differ.<\/p>\n<p>The groin is one possible source for small full-thickness grafts, not the ideal choice for every area. Thinner grafts can cover extensive surfaces but are not reserved exclusively for trauma. Selection depends on the recipient bed, dimensions, function, required colour and thickness and the patient\u2019s condition. The donor site also leaves an outcome that should be discussed.<\/p>\n<div class=\"im26-dg-gallery\">\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/4.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/4-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"6. Archive example of reconstruction with a skin graft.\"\/><\/a><figcaption>6. Archive example of reconstruction with a skin graft.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/5-1-300x225.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/5-1-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"18. Planning groin donor-site harvesting for a full-thickness graft.\"\/><\/a><figcaption>18. Planning groin donor-site harvesting for a full-thickness graft.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/6-1-300x225.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/6-1-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"19. Donor site illustrated in the archive in relation to a split-thickness graft.\"\/><\/a><figcaption>19. Donor site illustrated in the archive in relation to a split-thickness graft.<\/figcaption><\/figure>\n<\/div>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/melanoma\/treatment\/surgery\/surgery-remove-melanoma\">Cancer Research UK \u2014 Surgery to remove melanoma skin cancer<\/a>.<\/small><\/p>\n<\/section>\n<section class=\"im26-dg-section\" id=\"plastic-sentinella\">\n<h2>Sentinel lymph node localisation<\/h2>\n<p>These images show dye use, an operative field and equipment for intraoperative detection. Radiotracer and probe help identify first-draining lymph nodes; dye may provide additional guidance according to the protocol.<\/p>\n<p><a href=\"https:\/\/www.ilmelanoma.com\/en\/melanoma\/melanomas-surgical-therapy\/sentinel-limph-node-biopsy\/\">Sentinel lymph node biopsy<\/a> provides staging information when indicated. It is not the same as lymph-node clearance and does not eliminate false-negative results or complications. A device photograph does not certify procedural accuracy. Indication, coordination with excision and interpretation of results belong to the specialist pathway described in the dedicated guide.<\/p>\n<div class=\"im26-dg-gallery\">\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/5.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/5-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"7. Dye injection during sentinel lymph node localisation.\"\/><\/a><figcaption>7. Dye injection during sentinel lymph node localisation.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/6.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/6-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"8. Operative field during a sentinel lymph node procedure.\"\/><\/a><figcaption>8. Operative field during a sentinel lymph node procedure.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/7.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/7-300x231.jpg\" width=\"300\" height=\"231\" loading=\"lazy\" decoding=\"async\" alt=\"9. Equipment and probe for intraoperative radiotracer detection.\"\/><\/a><figcaption>9. Equipment and probe for intraoperative radiotracer detection.<\/figcaption><\/figure>\n<\/div>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39550033\/\">ESMO \u2014 Cutaneous melanoma: Clinical Practice Guideline (2024\/2025)<\/a>; <a href=\"https:\/\/www.nice.org.uk\/guidance\/ng14\/chapter\/Recommendations\">NICE NG14 \u2014 Melanoma: assessment and management<\/a>.<\/small><\/p>\n<\/section>\n<section class=\"im26-dg-section\" id=\"plastic-linfonodi\">\n<h2>Melanoma with clinically apparent nodal enlargement<\/h2>\n<p>The archive described this case as <a href=\"https:\/\/www.ilmelanoma.com\/en\/melanoma\/common-types-of-melanoma\/nodular-malignant-melanoma\/\">nodular melanoma<\/a> of the arm with axillary lymph-node enlargement. Suspicious nodal swelling requires diagnostic confirmation and staging: this is not a routine situation addressed solely by sentinel-node localisation.<\/p>\n<p>The historical caption called for immediate nodal clearance. Today, sequencing requires multidisciplinary discussion: neoadjuvant treatment may be appropriate in some resectable stage III cases according to evidence and access criteria. The photograph cannot establish this individual case\u2019s eligibility for present-day options.<\/p>\n<div class=\"im26-dg-gallery\">\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/8.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/8-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"10. Case described in the archive as arm melanoma with axillary nodal enlargement.\"\/><\/a><figcaption>10. Case described in the archive as arm melanoma with axillary nodal enlargement.<\/figcaption><\/figure>\n<\/div>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38828984\/\">NADINA \u2014 Neoadjuvant nivolumab and ipilimumab in resectable stage III melanoma (2024)<\/a>; <a href=\"https:\/\/www.aifa.gov.it\/documents\/20142\/3188844\/Allegato1_Nivolumab_Ipilimumab.pdf\">AIFA \u2014 Neoadjuvant nivolumab\u2013ipilimumab, Law 648\/1996 (17 November 2025)<\/a>; <a href=\"https:\/\/www.nice.org.uk\/guidance\/ng14\/chapter\/Recommendations\">NICE NG14 \u2014 Melanoma: assessment and management<\/a>.<\/small><\/p>\n<\/section>\n<section class=\"im26-dg-section\" id=\"plastic-piede\">\n<h2>Extensive foot lesions and preserving function<\/h2>\n<p>The photograph documents a large pigmented forefoot lesion for which the archive described a major ablative operation. It cannot independently establish diagnosis, depth or the need for amputation. Before irreversible surgery, clinical assessment, histological confirmation and oncological and reconstructive planning are required.<\/p>\n<p>At acral and nail sites, balancing margins, coverage and function requires particular expertise. A targeted partial biopsy may be selected when complete diagnostic removal would be disproportionate. Tissue-preserving options are not always feasible, but a historical case should not become a universal indication for amputation.<\/p>\n<div class=\"im26-dg-gallery\">\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/9-300x225.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/9-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"11. Extensive pigmented forefoot lesion: the photograph alone does not determine treatment.\"\/><\/a><figcaption>11. Extensive pigmented forefoot lesion: the photograph alone does not determine treatment.<\/figcaption><\/figure>\n<\/div>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39550033\/\">ESMO \u2014 Cutaneous melanoma: Clinical Practice Guideline (2024\/2025)<\/a>; <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6815042\/\">JCOG1602\/J-NAIL \u2014 Protocol for non-amputative digit-preserving surgery (2019)<\/a>.<\/small><\/p>\n<\/section>\n<section class=\"im26-dg-section\" id=\"plastic-recidive\">\n<h2>Recurrence and symptom control<\/h2>\n<p>The first image was described as a subcutaneous recurrence near the knee. The following three belong to archive sequence 12a\u201312c, concerning surgery for advanced disease in the head-and-neck region. They are kept together to preserve the documentation\u2019s context without assigning an unavailable oncological outcome.<\/p>\n<p>Surgery for recurrence or metastases can have different goals: removal of selected disease, local control or reduction of bleeding, ulceration or pain. A lesion appearing solitary in a photograph does not establish that it is the only disease site. Staging and its relationship with immunotherapy, targeted treatments or other approaches are essential to decision-making.<\/p>\n<div class=\"im26-dg-gallery\">\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/11-300x225.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/11-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"12. Archive case described as subcutaneous recurrence near the knee.\"\/><\/a><figcaption>12. Archive case described as subcutaneous recurrence near the knee.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/12a-225x300.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/12a-225x300.jpg\" width=\"225\" height=\"300\" loading=\"lazy\" decoding=\"async\" alt=\"13. Original sequence 12a: surgical planning in the head-and-neck region.\"\/><\/a><figcaption>13. Original sequence 12a: surgical planning in the head-and-neck region.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/12b-225x300.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/12b-225x300.jpg\" width=\"225\" height=\"300\" loading=\"lazy\" decoding=\"async\" alt=\"14. Original sequence 12b: intraoperative documentation from the same image group.\"\/><\/a><figcaption>14. Original sequence 12b: intraoperative documentation from the same image group.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/12c-225x300.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/12c-225x300.jpg\" width=\"225\" height=\"300\" loading=\"lazy\" decoding=\"async\" alt=\"15. Original sequence 12c: postoperative appearance documented in the archive.\"\/><\/a><figcaption>15. Original sequence 12c: postoperative appearance documented in the archive.<\/figcaption><\/figure>\n<\/div>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/www.nice.org.uk\/guidance\/ng14\/chapter\/Recommendations\">NICE NG14 \u2014 Melanoma: assessment and management<\/a>; <a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/melanoma\/treatment\/surgery\/surgery-remove-melanoma\">Cancer Research UK \u2014 Surgery to remove melanoma skin cancer<\/a>.<\/small><\/p>\n<\/section>\n<section class=\"im26-dg-section\" id=\"plastic-complicanze\">\n<h2>Complications and new lesions near a scar<\/h2>\n<p>The leg photograph was described as skin necrosis; the next as satellite lesions near the operated site. These are different problems: the first concerns tissue viability and healing, while the second requires cancer assessment. An image cannot attribute a complication to surgical error or confirm the nature of a new lesion without investigation.<\/p>\n<p>Satellite nodules or lesions are not necessarily dark: they may be small or reddish. A change near the scar warrants assessment and should not automatically be considered a normal consequence of surgery. Increasing pain, fever, discharge, bleeding or important wound changes should be reported to the centre. Clinical <a href=\"https:\/\/www.ilmelanoma.com\/en\/melanoma\/what-to-do-after-melanoma\/\">follow-up<\/a> complements this photographic documentation rather than being replaced by it.<\/p>\n<div class=\"im26-dg-gallery\">\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/3-1-300x197.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/3-1-300x197.jpg\" width=\"300\" height=\"197\" loading=\"lazy\" decoding=\"async\" alt=\"16. Complication described as leg skin necrosis in the archive; its cause cannot be determined from the photograph.\"\/><\/a><figcaption>16. Complication described as leg skin necrosis in the archive; its cause cannot be determined from the photograph.<\/figcaption><\/figure>\n<figure><a href=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/4-1-300x225.jpg\"><img loading=\"lazy\" src=\"https:\/\/www.ilmelanoma.com\/wp-content\/uploads\/2012\/01\/4-1-300x225.jpg\" width=\"300\" height=\"225\" loading=\"lazy\" decoding=\"async\" alt=\"17. Case described as satellite lesions near the operated site: clinical assessment is necessary.\"\/><\/a><figcaption>17. Case described as satellite lesions near the operated site: clinical assessment is necessary.<\/figcaption><\/figure>\n<\/div>\n<p class=\"im26-dg-sources\"><small>Sources: <a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/melanoma\/treatment\/surgery\/surgery-remove-melanoma\">Cancer Research UK \u2014 Surgery to remove melanoma skin cancer<\/a>; <a href=\"https:\/\/www.nice.org.uk\/guidance\/ng14\/chapter\/Recommendations\">NICE NG14 \u2014 Melanoma: assessment and management<\/a>.<\/small><\/p>\n<\/section>\n<aside class=\"im26-dg-related\">\n<h2>Continue the pathway<\/h2>\n<ul>\n<li><a href=\"https:\/\/www.ilmelanoma.com\/en\/melanoma\/melanoma-plastic-surgery\/\">Plastic and reconstructive surgery for melanoma<\/a><\/li>\n<li><a href=\"https:\/\/www.ilmelanoma.com\/en\/melanoma\/melanomas-surgical-therapy\/\">Surgical treatment of melanoma<\/a><\/li>\n<li><a href=\"https:\/\/www.ilmelanoma.com\/en\/melanoma\/melanomas-medical-therapy\/\">Medical treatment of melanoma<\/a><\/li>\n<\/ul>\n<\/aside>\n<section class=\"im26-dg-sources\">\n<h2>Sources and update<\/h2>\n<ul>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39550033\/\">ESMO \u2014 Cutaneous melanoma: Clinical Practice Guideline (2024\/2025)<\/a><\/li>\n<li><a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/melanoma\/treatment\/surgery\/surgery-remove-melanoma\">Cancer Research UK \u2014 Surgery to remove melanoma skin cancer<\/a><\/li>\n<li><a href=\"https:\/\/www.cuh.nhs.uk\/patient-information\/care-of-your-scar\/\">Cambridge University Hospitals \u2014 Care of your scar<\/a><\/li>\n<li><a href=\"https:\/\/www.nice.org.uk\/guidance\/ng14\/chapter\/Recommendations\">NICE NG14 \u2014 Melanoma: assessment and management<\/a><\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38828984\/\">NADINA \u2014 Neoadjuvant nivolumab and ipilimumab in resectable stage III melanoma (2024)<\/a><\/li>\n<li><a href=\"https:\/\/www.aifa.gov.it\/documents\/20142\/3188844\/Allegato1_Nivolumab_Ipilimumab.pdf\">AIFA \u2014 Neoadjuvant nivolumab\u2013ipilimumab, Law 648\/1996 (17 November 2025)<\/a><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6815042\/\">JCOG1602\/J-NAIL \u2014 Protocol for non-amputative digit-preserving surgery (2019)<\/a><\/li>\n<\/ul>\n<p>Editorial revision and source consultation: 17 October 2026. The original contribution is distinguished from the editorial update; no renewed specialist clinical review is certified.<\/p>\n<\/section>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>A photographic pathway through the clinical archive: excision, reconstruction, lymph nodes and symptom control, with updated captions.<\/p>\n","protected":false},"author":13,"featured_media":0,"parent":10327,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6870","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Atlas of melanoma plastic surgery<\/title>\n<meta name=\"description\" content=\"Atlas of melanoma surgery by Dr Daniele Gandini\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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