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.
Learn more about:
- Surgery (wide local excision)
- Checking for a clear margin
- Repairing the wound
- What to expect after surgery
Most people diagnosed with melanoma have more surgery after the spot has been removed with an excision biopsy. The second surgery removes more normal-looking skin from around the melanoma (wider margin). This is known as a wide local excision.
Removing more skin around the melanoma reduces the risk of it coming back (recurring) at that site. The width of the margin is usually between 5 mm and 10 mm, depending on the type, thickness and location 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 if there are no complications. If the melanoma is thicker than 1 mm or is considered high risk for spread to the lymph nodes, the doctor will discuss the risks and benefits of a sentinel lymph node biopsy. If you need a sentinel node biopsy, it is done 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.Pete
Checking for a clear margin
After a wide local excision, the tissue removed from around the melanoma will be sent to a laboratory. The pathologist will check that the required margin has been taken; this is called a clear margin. If the margins need to be wider, you may need to have further surgery to remove more tissue.
The wound is often closed with stitches. You will have a scar but this will usually become less noticeable with time. If a large area of skin is removed, the surgeon may repair the wound 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, usually over a few weeks.
Whether the surgeon does 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.
In either case, the wound will be covered with a dressing. After several days, the doctor will check to see if the wound is healing properly. If you had a skin graft, you will also have a dressing on any area that had skin removed for the graft.
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 pain medicine if necessary.
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.
Skin changesIf 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.
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 1–2 weeks. Ask your doctor how long to wait before returning to your usual exercise and activities.
When to seek adviceTalk to your doctor if you have any unexpected bleeding, bruising, infection, scarring or numbness after surgery.
Surgery for melanoma often leaves a scar, but this will usually fade with time. If you’re worried about how the scar looks, especially if it’s on your face, you can use cosmetics, hairstyles and clothing to help cover the scar. Look Good Feel Better is a national program that helps people manage the appearance- related effects of cancer treatment. For information about workshops in your area, call 1800 650 960 or visit Look Good Feel Better.
Podcast: Making Treatment Decisions
Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland, Diamantina Institute, and Consultant, Dermatology Department, Princess Alexandra Hospital, QLD; A/Prof Matteo Carlino, Medical Oncologist, Blacktown and Westmead Hospitals, Melanoma Institute Australia and The University of Sydney, NSW; Prof Anne Cust, Deputy Director, The Daffodil Centre, The University of Sydney and Cancer Council NSW, Chair, National Skin Cancer Committee, Cancer Council and faculty member, Melanoma Institute Australia; Prof Diona Damian, Dermatologist, Head of Department, Dermatology, The University of Sydney at Royal Prince Alfred Hospital, NSW, and Melanoma Institute Australia; A/Prof Paul Fishburn, General Practitioner – Skin Cancer, Norwest Skin Cancer Clinic, NSW and The University of Queensland; Claire Kelly, National Support Manager, and Emma Zurawel, Telehealth Nurse, Melanoma Patients Australia; Prof John Kelly, Consultant Dermatologist, Victorian Melanoma Service, The Alfred Melbourne and Monash University, VIC; Liz King, Manager, Skin Cancer Prevention Unit, Cancer Council NSW; Lee-Ann Lovegrove, Consumer; Lynda McKinley, 13 11 20 Consultant, Cancer Council Queensland; Angelica Miller, Melanoma Community Support Nurse, Melanoma Institute Australia incorporating melanomaWA, and Cancer Wellness Centre, WA; Dr Amelia Smit, Research Fellow, Melanoma and Skin Cancer, The Daffodil Centre, The University of Sydney and Cancer Council NSW; Prof Andrew Spillane, Professor of Surgical Oncology, The University of Sydney, The Mater and Royal North Shore Hospitals, NSW, and Melanoma Institute Australia; Kylie Tilley, Consumer; A/Prof Tim Wang, Radiation Oncologist, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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