Surgery for melanoma

Surgery is the main treatment for melanoma skin cancer. 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 melanoma and how thick it is.

You normally 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 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

• where the melanoma is on your body

• whether the surgery will affect your movement afterwards (for example, if the melanoma is close to a joint)

Your doctor usually removes at least:

• 0.5cm of tissue around the melanoma for stage 0 melanoma (melanoma insitu)

• 1cm of tissue around the melanoma for stage 1

• 2cm of tissue around the melanoma for stage 2

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.

Your doctor uses stitches or clips to close 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.

The tissue they remove is sent to the laboratory to check for cancer cells.

Some people might need to be asleep for the operation. This means you have a general anaesthetic . You have this if your doctor needs to:

• check your lymph nodes (sentinel lymph 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 well without one.

Skin graft

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

They usually take the donor skin from where it won’t be too obvious. 

How thick a piece of skin they take depends on which part of the body the graft is going on. If the skin graft is to cover a small area of your face, they may take a thicker piece of skin. This may be from behind your ear or the top inside of your arm.

Sometimes your doctor may take a thinner piece of skin. They might do this if the graft needs to cover a larger area. Or if the skin graft isn’t going on your face. Your doctor may take this from your thigh.  

At first the donor 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.

Your doctor or nurse will tell you how to look after the graft and the donor site.

Skin flap

For a skin flap, your surgeon takes some skin from an area next to where the melanoma was. This piece of skin isn’t cut out completely. It is still connected in a small area so it has its own blood supply. Your surgeon moves the piece of skin around to cover where the melanoma was.

There are different types of skin flaps and sometimes you may need more than one operation. Your surgeon will explain what you need before you have the operation.

Skin flaps are often used for the face. Your surgeon will do their best to hide the cuts (incisions) they make in the natural lines of your face.

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. If you had a skin graft, you normally have a dressing over the donor site too. Your doctor or nurse will tell how to look after the wounds and dressing.

Your surgeon may use dissolvable stitches to close the wound. These don’t need to be removed. Other types of stitches or clips do need to be removed. Your doctor or nurse will tell you when they need removing. But it is normally 5 to 14 days after your surgery. You may have to go to the hospital to have them taken out. Or you might have to make an appointment with the practice nurse at your GP surgery. 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

After having an operation under general anaesthetic you go to the recovery room. A nurse regularly checks you. You might be in the recovery room for a couple of hours. When you are awake enough you will go back to the ward. The ward staff will give you something to eat and drink.

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

• cook or use machinery

• sign any legal documents or make any important decisions

• look after children or care for other people

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 it outweigh any possible risks.

Your doctor or nurse will let you know what to look out for after surgery. They will also tell you who to contact if you have any problems.

Problems you might get include:

Pain

You might have some mild pain at the wound site. Or at the site you had the skin graft taken from. 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 you have a temperature or if your wound:

• looks red

• is very sore and getting more painful

• has fluid (discharge) leaking from it

• feels warm to the touch

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. But it can take several weeks. 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 the bleeding 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

It takes a few weeks after surgery to get the results. Your doctor or nurse will tell you when to expect them. They may send them by letter and explain when they need to see you again. Or your doctor may give you the results in person. They will also:

• examine you if you see them in person

• ask how you are and if you've had any problems

• check how your wound or wounds are healing

• plan further treatment if necessary

• tell you when to expect the next follow up appointment

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.

If you get your results by letter, or are between appointments, you can contact your specialist nurse if you have any questions. Specialist nurses are called key workers in some hospitals.

Surgery to remove melanoma that has spread

You might have surgery to remove melanoma that has spread to another area of skin or the body, such as the lungs or bowel. Cancer that has spread to another area of the body is called secondary cancer 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. You need to be reasonably fit and well to have this operation.

Unfortunately, it is not usually possible to cure melanoma that has spread. 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. The aim of these treatments is to control the cancer and relieve symptoms.