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Melanoma treatment in Edinburgh

Melanoma needs prompt, expert assessment and surgical excision, with every confirmed case discussed at the regional multidisciplinary team meeting. Both our consultants sit on that team and treat melanoma in their NHS practice as well as at Waterfront.

Your consultants
Dermatoscope examination of a mole on the calf
First appointment
Typically 1-2 weeks

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When to seek a melanoma assessment

Patients commonly book a melanoma assessment when they have noticed one of the following.

  • A new pigmented mole appearing in adulthood.
  • An existing mole that has changed in size, shape, colour, or behaviour — particularly asymmetry, irregular borders, multiple colours, or a diameter increasing beyond 6mm.
  • A mole that has started to bleed, itch, or crust.
  • A pigmented lesion that looks different from the rest of your moles.
  • A family history of melanoma, particularly in a first-degree relative.
  • Multiple atypical moles or a personal history of skin cancer.

Most pigmented lesions assessed by a consultant are benign. The purpose of the assessment is to identify the small proportion that need a biopsy and to start the diagnostic pathway promptly where it is required.

How melanoma is diagnosed and treated at Waterfront

Melanoma is diagnosed by histology: a suspicious lesion is removed in full by excisional biopsy under local anaesthetic, with results normally within two weeks. Confirmed melanomas are discussed at the South East Scotland Melanoma Multidisciplinary Team — which Mr Aldridge chairs and on which Mr Nassar sits — and for most early melanomas the next step is a wide local excision, with reconstruction performed by the same consultant where required.

Sentinel lymph node biopsy and any systemic treatment are arranged through the MDT and delivered in the NHS pathway by the same consultants, preserving continuity across both settings.

A gloved hand examining a mole on a woman's shoulder

What to expect from melanoma treatment

The most common pathway is excisional biopsy under local anaesthetic, followed — after MDT discussion — by wide local excision with or without reconstruction. Most early melanomas are managed with this two-stage surgical pathway alone.

Outcomes depend on stage at diagnosis. Melanomas detected early (thin melanomas, Breslow under 1.0mm, no ulceration) have very good long-term survival after wide local excision. Thicker melanomas, ulcerated melanomas, or those with positive sentinel lymph nodes require staging and surveillance, and may require systemic treatment through the NHS oncology pathway.

Where reconstruction is needed, the goal is to restore the contour of the affected area while keeping the wound under tension low enough to support healing and minimise scarring. Reconstruction is planned at the same time as wide local excision by the consultant performing the surgery.

What melanoma surgery can and can’t do

For most early melanomas, two operations, an excision biopsy and then a wide local excision, are the whole treatment. Surgery cannot promise the melanoma will never return, and some of the pathway sits outside Waterfront.

It can

  • Remove the suspicious lesion in full so a pathologist can confirm the diagnosis and measure its thickness.
  • Take a wider margin of skin around the scar, set by national guidance for the stage, to reduce the chance of it returning at that site.
  • Reconstruct the area in the same operation where the site needs it.
  • Put every confirmed melanoma in front of the regional melanoma team, which both consultants sit on.

It can’t

  • Tell you the stage before the histology is back. Thickness, ulceration and mitotic rate come from the microscope, usually within two weeks, and they set everything that follows.
  • Guarantee it will not come back. Most early melanomas do not recur, but recurrence remains possible at any stage, which is why follow-up is structured.
  • Stop a second melanoma. About 1 in 20 people develop another melanoma over the following 20 years, and other skin cancers are more common too.
  • Be done without a scar. A wide local excision leaves a longer scar than the first operation, and a flap or graft where the site needs it.
  • Include sentinel lymph node biopsy or drug treatment. These are arranged through the regional team and delivered in the NHS, often by the same consultant.

Your consultant will tell you at your consultation which of these apply to you.

What does melanoma treatment cost?

Pricing depends on the stage of the pathway.

Histology fees are included where a specimen is sent for analysis.

Sentinel lymph node biopsy and any systemic treatment are not delivered at Waterfront and are not part of these prices. They are arranged through the MDT and the NHS pathway. The full price of any onward treatment delivered at Waterfront is confirmed in writing before the procedure is booked.

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Questions before you book?

Ask anything about melanoma treatment, its recovery, risks or cost, any time and in plain language. If you would like, our team can contact you afterwards.

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Patients often ask

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Quick answers

Will the same consultant handle my full melanoma pathway?
At Waterfront, yes — your excisional biopsy, wide local excision, reconstruction, and Waterfront follow-up are performed by the consultant who first assessed you. Both Mr Aldridge and Mr Nassar also treat melanoma in their NHS practice, so where sentinel lymph node biopsy, lymph node clearance, or systemic treatment is required through the NHS pathway, the same consultant who treated you at Waterfront may also be the consultant managing you in the NHS.
How quickly can I be seen?
Melanoma assessment appointments are normally available within 1-2 weeks of booking.
How long does histology take?
Histology results from an excisional biopsy normally return within approximately two weeks. The result is communicated to you by the consultant who took the biopsy, usually within two weeks of the result returning.
What happens if histology confirms melanoma?
The case is discussed at the South East Scotland Melanoma Multidisciplinary Team, which Mr Aldridge chairs and on which Mr Nassar also sits. The MDT reviews the histology — including Breslow thickness, ulceration, mitotic rate, and margins — and recommends the next steps. These commonly include a wide local excision, which can be performed at Waterfront, and consideration of sentinel lymph node biopsy where indicated.
What is a wide local excision?
A wide local excision is a second surgical procedure to remove a margin of skin around the site of the original excisional biopsy. The width of the margin is set by national guidelines and depends on the Breslow thickness of the melanoma. Reconstruction with a skin flap or graft is planned at the same time where the site requires it.
Will I need a sentinel lymph node biopsy?
Sentinel lymph node biopsy is considered for melanomas thicker than 1mm, and for those between 0.8mm and 1mm with higher-risk features such as ulceration. Whether you need one is decided at the MDT, based on the histology of your excisional biopsy.
Where does sentinel lymph node biopsy happen?
Sentinel lymph node biopsy is not performed at Waterfront. It is arranged through the MDT and delivered in the NHS pathway. Both Mr Aldridge and Mr Nassar treat melanoma in their NHS practice — including sentinel lymph node biopsy and lymph node clearance — so the consultant who treated you at Waterfront may also be the consultant managing you in the NHS.
What if my melanoma needs systemic treatment?
Systemic treatment — including immunotherapy or targeted therapy for stage III and IV melanoma — is not delivered at Waterfront. It is arranged through the MDT and the relevant NHS oncology service.
How much does melanoma treatment cost?
Consultation is £200. Excisional biopsy starts from £1,495. Wide local excision with reconstruction starts from £2,195, with final pricing set after consultation based on the lesion site, the size of the excision, and the reconstruction required. The price covers the surgeon’s fee, the anaesthetist’s fee where applicable, the hospital and theatre fee at Waterfront, and post-operative reviews until you are fully discharged. Sentinel lymph node biopsy and systemic treatment are arranged through the NHS pathway and are not part of these prices.
What is the recurrence risk after wide local excision?
Recurrence risk depends on the stage of the melanoma at diagnosis. Early melanomas (thin, non-ulcerated) have very low recurrence rates. Higher-risk melanomas — thicker, ulcerated, or with positive sentinel lymph nodes — have higher recurrence rates and are followed for longer. The detailed risk for your individual case is discussed with your consultant once histology and any further staging are available.
How long is the follow-up for melanoma?
The follow-up schedule is set by stage and follows national guidelines. Follow-up is set by the stage of the melanoma, in line with national guidance, and your consultant will set out your schedule. Surveillance is normally delivered through the NHS pathway by the same consultants who treat you at Waterfront; where preferred, ongoing surveillance can also be arranged at Waterfront.
Which consultant will I see?
Melanoma assessment, excisional biopsy, wide local excision, and reconstruction at Waterfront are performed by Mr Ben Aldridge or by Mr Kazem Nassar. Both are on the GMC Specialist Register and both sit on the South East Scotland Melanoma MDT. Mr Aldridge chairs the MDT and is the UK’s only consultant dual-qualified in dermatology and plastic surgery; Mr Nassar is a consultant plastic and reconstructive surgeon.

Our melanoma consultants

Melanoma diagnosis, excisional biopsy, wide local excision, and reconstruction at Waterfront are performed by Mr Ben Aldridge — the UK’s only consultant dual-qualified in dermatology and plastic surgery, with a PhD in skin lesion diagnostics, co-author of national skin cancer guidelines, and chair of the South East Scotland Melanoma Multidisciplinary Team — and by Mr Kazem Nassar, consultant plastic and reconstructive surgeon. Both consultants are on the GMC Specialist Register and sit on the South East Scotland Melanoma MDT. Both treat melanoma in their NHS practice — including sentinel lymph node biopsy and lymph node clearance — providing continuity between Waterfront and NHS care.

You meet your consultant at your first appointment. The same consultant plans your treatment, carries it out and sees you afterwards.

Mr Ben Aldridge

Consultant plastic and dermatological surgeon

GMC Specialist Register (Plastic Surgery)Dual trained in dermatology

Mr Kazem Nassar

Consultant plastic surgeon

GMC Specialist Register (Plastic Surgery)

Risks, and how often they happen

Every procedure carries risk. Here they are in three groups, with how often they happen where the evidence allows. Your consultant will go through them with you, and they are in your written consent.

Expected Almost everyone, and they settle

  • A scar, longer than the lesion after the biopsy, and longer again after the wide local excision, or in the shape of a flap or graft. It is red or pink at first and fades over 12 to 18 months.
  • Swelling and bruising around the wound for the first one to two weeks.
  • Discomfort for a day or two, eased by simple painkillers.
  • Numbness or altered sensation around the scar, which usually settles over weeks to months and occasionally persists.
  • A wait for results. Histology from the biopsy normally takes about two weeks, and the regional team meets before the next step is set.

Uncommon Some patients, and some need further treatment

  • Melanoma at or close to the edge of the excision on histology, which is taken into account when the wide local excision margin is planned or discussed at the regional meeting.
    Uncommonno reliable figure
  • Wound infection that needs a course of antibiotics.
    Under 1 in 50higher below the knee, in the groin and after a skin graft
  • Bleeding after surgery that needs pressure, a dressing change or a return to have the wound checked.
    Under 1 in 100about 1 in 20 after a skin graft, and higher on warfarin
  • Wound breakdown, or partial loss of a flap or graft, which heals with dressings but can leave a wider scar.
    Under 1 in 100more likely with a graft, on the lower leg, or in smokers
  • A raised, thickened scar (hypertrophic or keloid), more likely on the chest, shoulders, upper back and earlobes and in darker skin. It can be treated but not always fully flattened.
    Uncommonno reliable figure

Rare but serious

  • The melanoma coming back or spreading, at the scar, in nearby skin, in the lymph nodes or elsewhere. The risk is set by stage, and for stage 1 melanoma almost everyone is alive five years later.
    Set by stagesee the long-term section
  • Injury to a nerve beneath the skin on the face, neck or limbs, which can cause lasting numbness or, rarely, weakness of a nearby muscle. Your consultant plans around the known danger zones.
    Rareno reliable figure
  • An allergic reaction to the blue dye used in sentinel lymph node biopsy, where that is done in the NHS.
    About 1 in 1,000sentinel node biopsy only
  • A serious reaction to the local anaesthetic.
    Very rare
  • A serious reaction to a general anaesthetic, where one is used for a larger reconstruction.
    Very raregeneral anaesthetic cases only

For the long term

  • Survival depends on stage. In England, almost everyone with stage 1 melanoma, about 85 in 100 with stage 2 and about 75 in 100 with stage 3 are alive five years after diagnosis.
  • Follow-up follows national guidance. How often and for how long you are seen depends on the stage of your melanoma, and your consultant will set out your schedule.
  • A second melanoma is possible. About 1 in 20 people develop another over 20 years. Check your skin monthly and report any new or changing spot promptly.
  • Sentinel lymph node biopsy is considered for melanomas thicker than 1mm, and for those between 0.8mm and 1mm with higher-risk features. It is a staging test, not a treatment, and it is done in the NHS under general anaesthetic.
Where these figures come from

Figures are drawn from UK national guidance and published studies, and your own risk may be higher or lower. More from the British Association of Dermatologists on stage 1 melanoma and from the NHS on treating melanoma.

Aftercare and follow-up

After excisional biopsy or wide local excision at Waterfront, a nurse reviews the wound at one week, and more often if needed in the early healing period. Your consultant reviews you at around six months once the result has settled. Between then, your consultant is always available — if anything concerns you, they will respond directly and arrange to see you as soon as needed.

Long-term surveillance after melanoma is set by stage and follows national guidelines. Follow-up is set by the stage of the melanoma, in line with national guidance, and your consultant will set out your schedule.

Surveillance is normally delivered through the NHS pathway by the same consultants who treat you at Waterfront. Where preferred, ongoing surveillance can also be arranged at Waterfront.

  1. Day of surgeryHome within the hour. Most skin surgery is under local anaesthetic.
  2. Next dayBack to office work. Heavy, dirty or wet jobs need a few days.
  3. Days 7–14Stitches out at Waterfront.
  4. 3–4 weeksHistology results, where a sample is sent to the laboratory.
  5. 12 monthsNurse reviews, dressing clinics and the treatment of any complications are included.

Typical timings. Your consultant and nurse will tailor them to you.

A Waterfront nurse with a tablet talking with a patient

Written by

Mr Kazem Nassar, consultant plastic surgeon

Mr Kazem Nassar, MBChB, FRCS (Plast), GMC 7131999, is a Plastic and Reconstructive Surgeon Consultant with over 10 years of experience. He practices at St John’s Hospital and the Western General Hospital in Edinburgh, specialising in melanoma, skin cancer treatments, breast surgery, and post-cancer reconstructive surgery.

Mr Ben Aldridge, consultant plastic and dermatological surgeon

Mr Ben Aldridge, MB ChB, MSc, PhD, MRCP, FRCS (Plast), GMC [6049481], is a Consultant Dermatologist and Plastic Surgeon at Waterfront Private Hospital in Edinburgh. He is the UK's only consultant dual-qualified in dermatology and plastic surgery, holds a PhD in skin lesion diagnostics, is a co-author of national skin cancer guidelines, and chairs the South East Scotland Melanoma Multidisciplinary Team.