Surgery for melanoma

A doctor or surgeon will do a procedure called wide local excision (removal). This means that the area where the melanoma is, as well as a small amount of surrounding normal-looking skin, will be cut out. This is called a wider or safety margin.

Removing more tissue around the melanoma than was cut out during the excision biopsy reduces the risk of it coming back (recurring) locally. The safety 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 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 often have a sentinel node biopsy at the same time and will be given a general anaesthetic. The sentinel node biopsy may be less accurate if it is performed after the wide local excision has been done.

Most people will be able to have the surgical wound drawn together with stitches. When large skin cancers are removed, the wound may be too big to close with stitches. The surgeon may cover it using some skin from another part of your body.

This can be done in two ways:

• Skin flap – nearby skin and fatty tissue are moved over the wound and stitched.
• Skin graft – a layer of skin is taken from another part of your body and placed over the area where the melanoma was removed.

The decision about whether to do a skin graft or flap 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 and left for several days. It will then be checked to see if it is healing properly. You will also have dressings on any area that had skin removed for a graft.

You may be uncomfortable for a few days after a wide local excision. Your doctor will prescribe painkillers if necessary. If you have a skin graft, the area on which the skin is grafted may look red and raw immediately after the operation. Eventually this area will heal and the redness will fade.

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 take and a new one is required.

Your total recovery time will vary depending on the thickness of the melanoma and the extent of the surgery required. Most people recover in a week or two. Your doctor can also give you information about any bleeding, bruising, scarring or numbness you may have after surgery.

For more information about surgery, call Cancer Council 13 11 20 and request a free copy of Understanding Surgery, or download a digital copy from this page.

Watch this short video to learn more about surgery.