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What to Know About Surgery for Melanoma

What to Know About Surgery for Melanoma

Surgery is the most common way to treat melanoma and is a common treatment for all stages of melanoma.

You may still need other types of treatment before or after surgery. Talk with your doctor about what the surgery will do for you. Also ask what to expect after surgery.

What happens during surgery for melanoma

Any of these specialists may do surgery to remove melanoma:

  • Dermatologist

  • General surgeon

  • Plastic surgeon

  • Cancer surgeon 

Most likely you'll have the surgery in a doctor's office or outpatient setting of a hospital. For more involved surgeries, you may need to spend some time in the hospital. 

You may meet with the doctor beforehand. At this time, you can ask any questions and address any concerns you may have.

These are the types of surgery most often used to treat melanoma:

Wide local excision

This surgery takes place after the biopsy. Your surgeon uses biopsy results to tell how much of your normal tissue needs to be removed in that surgery. The goal of this surgery is to remove any stray melanoma cells near the main site. This can help prevent recurrence.

For a wide local excision, the surgeon removes the tumor. He or she also removes some normal skin around it to lower the risk of the cancer recurring.

The type of anesthetic used is determined by you and your doctor. In some cases, the surgery can be done with local anesthesia, which numbs the area but doesn't make you sleep.

Thin melanomas can be removed in a simple excision. Thicker tumors require a wide excision. In some cases, your doctor may try to remove less tissue to provide a good cosmetic effect. This might be true if the cancer is on your face.

If your doctor needs to remove a lot of skin, you may need a skin graft. For it, the surgeon takes skin from another part of your body to replace the skin that was removed. The doctor uses stitches to close small excisions. 

Sentinel node biopsy

In many cases, you may need this procedure done between the time of the biopsy and the wide local excision. Before this surgery, the doctor does a test to find the sentinel node, which is the lymph node that the cancer is likely to spread to first. For the test, the doctor injects a small amount of radioactive tracer around the site of the initial melanoma. At the time of surgery, the surgeon injects a blue dye at the same site of the initial melanoma. The dye tracer follows the same path as malignant cells would from the melanoma site. With the help of a radiation detector called a Geiger counter, the doctor is able to find the most radioactive spot, which is the sentinel node. The doctor then makes a small incision on that spot to remove the sentinel lymph node. A pathologist examines the removed lymph nodes. If melanoma is found, your doctor may suggest removing more lymph nodes. Doing this may help prevent the spread of the cancer. If the doctor doesn't find cancer in the sentinel node, your other nodes will likely be left in place because they are unlikely to contain cancer.

Lymph node dissection

If lymph nodes near the melanoma are enlarged or if cancer is found in the sentinel node, more extensive surgery may be needed to remove nearby lymph nodes in the area. This operation is known as a lymph node dissection. 

Amputation

If the melanoma is on your finger or toe, the doctor may suggest removing part of or the whole finger or toe. 

Surgery based on the stage of the melanoma

A slightly different type of surgery is used for each stage:

  • If you have stage 0 or I melanoma, wide local excision surgery is the standard treatment. The surgeon removes the tumor and some of the normal tissue around it. Without surgery, melanoma will spread to other parts of your body. For some stage I melanomas, the surgeon may recommend a sentinel lymph node biopsy. If cancer is found in the sentinel lymph node, the surgeon may also remove nearby lymph nodes.

  • If you have stage II or III melanoma, you may first need a sentinel node biopsy or a lymph node dissection to look for cancer in nearby lymph nodes. You'll also have surgery to take out the tumor. Depending on the size of the cut and the location on your body, you may need a skin graft to cover the wound made by the surgery.

  • If you have stage IV melanoma, your doctor may suggest surgery to remove tumors and ease symptoms caused by advanced melanoma. This is palliative therapy, meaning it gives relief but doesn't cure the cancer.

  • If you have melanoma on a finger or toe, the surgeon may amputate all or part of your finger or toe. 

What to expect after surgery

It will most likely take a couple of weeks for your incision to heal. During this time, you may experience these things. They can vary from person to person. The side effects will largely depend on the type of surgery that is done. Talk with your health care team before surgery so you know what to expect.

  • Bruising

  • Minor pain

  • Redness and swelling of incision site

  • Infection

  • Swelling in hands or arms, called lymphedema, after having lymph nodes removed

  • Scarring

If you’ve had skin grafts, you’ll learn from your doctor or nurse how to take care of them as they heal.

 
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