Surgery for melanoma

Surgery is the main treatment for melanoma. You might have surgery to remove: 

• an early stage melanoma
• the lymph nodes close to the melanoma if the cancer has spread there
• melanoma that has come back in the same place following an operation
• melanoma that has spread to other parts of the body

Surgery to remove more tissue (wide local excision)

Doctors diagnose melanoma by removing the abnormal mole or area of skin. They send it to the laboratory to check if it's a melanoma and how thick it is.

It's likely you'll have a second operation to remove more tissue if you're diagnosed with melanoma. This is called a wide local excision. Your doctor removes a larger area of healthy skin and tissue from around where the melanoma was. This helps to reduce the risk of the melanoma coming back.

How much tissue you have removed depends on:

• whether melanoma cells are in the surrounding skin and tissue
• how deep the melanoma has grown into the tissue beneath the skin
• the position of the melanoma on your body
• whether the surgery will affect your movement afterwards (for example, if the melanoma is close to a joint)

The National Institute for Health and Care Excellence (NICE) recommend that for :

• stage 0 melanoma (melanoma in situ), your doctor removes at least 0.5cm of tissue around the melanoma
• stage 1 melanoma, the surgeon removes at least 1 cm of tissue around the melanoma
• stage 2 melanoma, the surgeon removes at least 2 cm of tissue around the melanoma

What happens

Generally, this is a small operation. You usually have it as an outpatient, under local anaesthetic. This means you’re awake for the operation but have an injection to numb the area.

The doctor will put in stitches or clips to close up the area where they remove the tissue. This can feel a little tight at first. But as it heals, the surrounding skin stretches and the tightness should ease.

You might need to be asleep for the operation (have a general anaesthetic) if the doctor needs to:

• check your lymph nodes (sentinel node biopsy)
• remove a large area of skin or repair it with a skin graft or skin flap

Skin graft and skin flap

You might have a skin graft or flap to cover the wound if your doctor needs to remove a large area of skin.

Most people who have a wide local excision don’t need a skin graft or flap. The area can heal up well without one.

Skin graft

For a skin graft, your surgeon removes a thin sheet of skin from somewhere else on your body (the donor site). They then place it over the area where the melanoma was. 

The donor skin is usually taken from somewhere where it won’t be too obvious, such as your inner thigh or behind your ear. At first the area looks like a graze. It may feel quite sensitive or painful at first. The skin grows back quite quickly, usually over a couple of weeks.

The skin graft is very delicate while it heals. It’s vital that the graft is not damaged during this time. Try not to knock it. You might have antibiotics to help prevent an infection.

Skin flap

For a skin flap, your surgeon takes some skin with its own blood supply from an area next to where the melanoma was. There are different types of skin flaps and sometimes you may need more than one operation for the type of skin flap you’re having. Your surgeon explains what you need before you have the operation.

Skin flaps are often used for the face. Your surgeon will do their best to make sure the cuts (incisions) they make during the operation fit in with the natural lines of your face so that any scars are hidden.

Surgery to remove lymph nodes

If you have swollen lymph nodes near to the melanoma that your doctor can feel, you usually have an ultrasound scan and biopsy. Your doctor takes a sample from the nodes using a fine needle (fine needle aspiration ) or a core needle biopsy to check for cancer cells.

You might have surgery to remove the lymph nodes in the area if cancer has spread there. This is a lymph node dissection.

After your surgery

You can usually go home the same day as your surgery.

You have a dressing over your wound to protect it. This is usually kept in place for a day or more. If you have had a lymph node dissection you may have a drain that you can take home. 

Your surgeon may use dissolvable stitches to close the wound, which they don’t need to remove. For other types like stitches or clips you need to go back to the hospital 5 to 14 days after your surgery so the nurse can take them out. They will also check how your wound is healing.

If you’ve had a local anaesthetic to part of your face

Having a local anaesthetic to the middle or lower part of your face means that you won’t be able to feel anything until it has worn off. So you should avoid hot food and drink until the sensation has returned, as there is a risk of burns.

If you’ve had a general anaesthetic

You first go to the recovery area after having an operation under general anaesthetic. A nurse regularly checks you. They offer you a snack and drink when you are more awake. You might be in the recovery area for a couple of hours.

When the anaesthetic has worn off and you feel well you can go home. This might be on the evening of the operation or the next day.

After a general anaesthetic you’ll need a friend or relative to take you home and stay with you overnight. Also, for 24 hours after the general anaesthetic you shouldn’t:

• drive
• drink alcohol
• operate heavy machinery
• sign any legally binding documents

Problems after a wide local excision

As with any operation, there is a risk of complications. Before offering you surgery, your doctor makes sure the benefits of having the operation outweighs any possible risks.

Your doctor or nurse will let you know what to look out for after your surgery and who to contact if you have any problems. These might include:

Pain

You might have some mild pain at the wound site. Or at the site you had the skin graft. Simple pain relief like paracetamol can help. If it’s not helping contact your doctor to get stronger pain relief.

Infection

Some people get an infection after their operation. Contact your GP or the department where you had the surgery if your wound:

• looks red
• is very sore and getting more painful
• has fluid (discharge) leaking from it

You may need treatment such as antibiotics.

Numbness

You may have some numbness, tingling and pain in the area. This is due to nerve injury and may get better with time. Talk to your doctor or specialist nurse if this is troubling you. 

Bruising and swelling

You might have some bruising and swelling around the area of your operation. This goes down over time as the wound heals. Contact your doctor or nurse if the swelling gets worse.

Bleeding

You might have a small amount of bleeding after surgery. If your wound continues to bleed or gets worse contact the department where you had surgery or go to your local Accident and Emergency (A&E) department.

Avoid strenuous exercise or activity after surgery to reduce the risk of bleeding. Your doctor or nurse will tell you how long for.

Scarring

You'll have a scar. The size and shape of your scar will depend on how big the melanoma was and if you needed a skin graft or flap.

Scars are quite noticeable and red to start with, but they get paler and less noticeable over time. Some scars can be quite thick and raised (hypertrophic or keloid). Talk to your doctor about any worries you might have about your scar.

Follow up

You see your doctor about 4 to 6 weeks after surgery. Your doctor:

• gives you the results of the surgery
• examines you
• asks how you are and if you've had any problems
• checks how your wound or wounds are healing
• plans further treatment and follow up

This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says and provide support.

Between appointments, you can also contact your specialist nurse, they are also known as key workers in some hospitals. So don't worry if you do forget to ask something. 

How often you have follow up appointments depends on the results of your surgery. Ask your doctor how often you need to have check ups and what they will involve.

Surgery to remove melanoma that has spread

You might have surgery to remove melanoma that has spread to other areas of the skin or body, such as the lungs, skin and bowel. Cancer that has spread to another area of the body is called secondaries or metastases. The operation you have depends on which part of the body the melanoma has spread to.

For example, you might have surgery to remove a secondary melanoma in the skin. Or it might be possible for some people to have an operation to remove a secondary melanoma in their lung or bowel. This operation is more likely if there are no other signs of melanoma elsewhere in the body. And you need to be reasonably fit and well to have this operation.

It is not usually possible to cure the melanoma. But some people can stay well for months or sometimes years after having several different treatments such as surgery to remove metastases, targeted cancer drugs or immunotherapies.