Surgery for melanoma
Surgery to remove the mole is the main treatment for early melanoma, and it can also be the only treatment you need.
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Even though the excision biopsy to diagnose melanoma may remove the melanoma, a doctor or surgeon will usually recommend a second procedure known as a wide local excision. This means removing more normal-looking skin from around the melanoma (wider margin).
Removing more skin around the melanoma reduces the risk of it coming back (recurring) at that site. The recommended margin is usually between 5 mm and 10 mm, depending on the type, thickness and site of the melanoma. For thicker tumours, a wider margin of up to 20 mm may be advised.
A wide local excision is often performed as a day procedure. This means you can go home soon after the surgery, provided there are no complications. People with a melanoma thicker than 1 mm will usually be offered a sentinel lymph node biopsy performed at the same time as the wide local excision.
For more on this, see our general section on Surgery.
After the wide local excision, the wound looked red and was sore, but this improved within four weeks.Read more of Pete’s story
Most people will be able to have the wound closed with stitches. You will have a scar but this will become less noticeable with time.
If a large area of skin is removed, the wound may be too big to close with stitches. In this case, the surgeon may repair it using skin from another part of your body. This can be done in two ways:
Skin flap – Nearby skin and fatty tissue are lifted and moved over the wound from the edges and stitched.
Skin graft – A layer of skin is taken from another part of your body (most often the thigh or neck) and placed over the area where the melanoma was removed. The skin grows back quickly over a few weeks.
The decision about whether to do a skin flap or graft will depend on a number of factors, including:
- where the melanoma is
- how much tissue has been removed
- your general health.
After a wide local excision, the tissue removed from around the melanoma will be sent to a laboratory for testing. If the edge of the tissue sample doesn’t contain any cancer cells, it is called a clear margin. If the margins aren’t clear, you may need further surgery to remove more tissue.
Most people recover quickly after a wide local excision to remove a melanoma, but you will need to keep the wound clean.
Pain reliefThe area around the wide local excision may feel tight and tender for a few days. Your doctor will prescribe painkillers if necessary. If you have a skin graft, the area that had skin removed may look red and raw immediately after the operation. Over a few weeks, this area will heal and the redness will fade.
Wound careYour medical team will tell you how to keep the wound clean to prevent it from becoming infected. Occasionally, the original skin flap or graft doesn’t heal. In this case, you will need to have another procedure to create a new flap or graft.
Recovery timeThe time it takes to recover will vary depending on the thickness of the melanoma and the extent of the surgery required. Most people recover in a week or two. Ask your doctor how long you should wait before returning to your usual exercise activities.
When to seek adviceTalk to your doctor if you have any unexpected bleeding, bruising, infection, scarring or numbness after surgery.
Podcast: Making Treatment Decisions
A/Prof Robyn Saw, Surgical Oncologist, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, NSW; Craig Brewer, Consumer; Prof Bryan Burmeister, Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD; Tamara Dawson, Consumer, Melanoma & Skin Cancer Advocacy Network; Prof Georgina Long, Co-Medical Director, Melanoma Institute Australia, and Chair, Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, NSW; A/Prof Alexander Menzies, Medical Oncologist, Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Paige Preston, Chair, Cancer Council’s National Skin Cancer Committee, Cancer Council Australia; Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland Diamantina Institute, and Director, Dermatology Department, Princess Alexandra Hospital, QLD; Julie Teraci, Clinical Nurse Consultant and Coordinator, WA Kirkbride Melanoma Advisory Service, WA.
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