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 often removes the melanoma, a doctor or surgeon may also do a procedure called wide local excision. This means removing more normal-looking skin from around the melanoma (wider margin).
Removing more tissue around the melanoma reduces the risk of it coming back (recurring) at that site. In the latest melanoma guidelines, it is recommended that the margin is usually between 5 mm and 1 cm, depending on the type, thickness and site of the melanoma. For thicker tumours, a wider margin of up to 2 cm may be advised.
A wide local excision is often performed as a day procedure using a local anaesthetic. 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 at the same time.
For more on this, see Surgery.
After the wide local excision, the wound looked red and was sore, but this improved within four weeks. I was given a cream to apply to my arm to help the scar heal.
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 (usually 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 many factors, such as where the melanoma is, how much tissue has been removed and your general health. In either case, the wound will be covered with a dressing. After several days, it will be checked to see if the wound is healing properly. If you had a skin graft, you will also have dressings on any area that had skin removed for the graft.
The 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.
The 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.
Your 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 and a new one is required.
When to seek advice
Talk to your doctor about any side effects such as bleeding, bruising, infection, scarring or numbness you may have after surgery.
Video: What is surgery?
A/Prof Victoria Atkinson, Senior Staff Specialist, Princess Alexandra Hospital, Visiting Medical Oncologist, Greenslopes Private Hospital, and The University of Queensland Clinical School of Medicine, QLD; Adjunct Prof John Kelly AM, Consultant Dermatologist, Victorian Melanoma Service, and Department of Medicine at Alfred Health, Monash University, VIC; Dr Alex Chamberlain, Dermatologist, Glenferrie Dermatology, Victorian Melanoma Service and Monash Univeristy, VIC; Alison Button-Sloan, Melanoma Patients Australia; Peter Cagney, Consumer; Prof Brendon J Coventry, Associate Professor of Surgery, The University of Adelaide, Surgical Oncologist, Royal Adelaide Hospital, and Research Director, Australian Melanoma Research Foundation, SA; Dr David Gyorki, Consultant Surgical Oncologist, Peter MacCallum Cancer Centre, VIC; Liz King, Skin Cancer Prevention Manager, Cancer Council NSW; Shannon Jones, SunSmart Health Professionals Coordinator, Cancer Council Victoria; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Prof Richard Scolyer, Senior Staff Specialist, Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Co-Medical Director, Melanoma Institute Australia and Clinical Professor, The University of Sydney, NSW; Heather Walker, Chair, Cancer Council National Skin Cancer Committee, Cancer Council Australia. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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