Surgery for melanoma
Most people diagnosed with melanoma will have further surgery after their mole has been removed.
About surgery for melanoma
Surgery is usually the main treatment for melanoma that has not spread. It may be the only treatment you need. The aim is to remove the cancer cells completely and the surrounding area of healthy tissue. This is called wide local excision surgery (WLE).
You may have a wide local excision:
- If you had an abnormal mole removed (an excision biopsy) and this showed it was a melanoma. The aim is to reduce the risk of melanoma coming back.
- To remove melanoma that has come back in the same area.
Surgery for advanced melanoma
Having a wide local excision (WLE)
Before the operation, your doctor will talk to you about how much tissue needs to be removed. The amount that is taken depends on how thick the melanoma was.
You usually have a WLE under a local anaesthetic, in a day surgery unit. This means you are awake, but you do not feel the surgery. You will have an injection to numb the area where the operation is done.
Sometimes a WLE is done under a general anaesthetic. This means you are asleep during the operation.
The doctor carefully removes the area of tissue. Depending on the size of the wound and where it is, they may:
- leave the area to heal naturally
- close the wound with stitches
- cover the wound with a skin graft
- cover the wound with a skin flap.
A skin graft is a layer of skin that is taken from another part of the body and placed over the area where the melanoma was removed.
A skip flap is a slightly thicker layer of skin than a graft. It is taken from an area very close to where the melanoma was removed.
Checking the lymph nodes
After a WLE
After surgery, your doctor or nurse will explain how to look after the wound. They will also tell you who to contact if you have wound problems such as:
- bleeding that will not stop
- signs of infection including wound redness, pain, heat or pus.
You can usually go home soon after the operation. You may need to stay longer or overnight if you have a general anaesthetic and sometimes after skin graft surgery. You may need to stay for a few days after skin flap surgery. Your doctor or nurse can give you more information.
Wounds
Your wound may look red and swollen at first, but this will gradually get better. You will be given painkillers to help after the operation.
Your nurse will explain if you have stitches that need to be removed. Your nurse may also give you dressings to protect the wound while it heals. They will explain when and how to change your dressing.
If you had a skin graft, you will also have a wound where the skin was taken from. This is called the donor site. How long this area takes to heal depends on how much skin was removed.
Try not to do too much in the first 2 weeks after skin graft surgery. It is important not to put pressure on the grafted area such as rubbing or brushing against it. The skin graft takes about 5 to 7 days to connect with the blood supply in the area.
Scar
Removing tissue during a WLE will always leave a mark on the skin. Before your operation, your doctor will explain what to expect. Your scar after melanoma removal depends on the location and amount of tissue that was removed.
If you had a skin graft, you will have a scar in both the grafted and the donor site area. There will also be some differences between the grafted skin and the skin surrounding it. But this will become less noticeable over time.
If scars after surgery bother you or make you feel self-conscious, our information about body image and cancer may help. Some skin clinics have a make-up specialist who can give you advice on the best way to cover up scars.
Further tests and treatment
If all the melanoma cells are removed during your wide local excision, you will not need any more treatment.
Tests to check the lymph nodes may show melanoma cells in the lymph nodes. In this situation you may be offered further surgery to remove all the nearby lymph nodes. Your cancer doctor will talk to you about whether this may be helpful in your situation.
If the melanoma has spread to the lymph nodes, you might be offered further treatment with targeted therapy or immunotherapy
Depending on your surgery, you may have some small scars or areas of skin that look different. Changes to your appearance may make you worried about your body image. Some skin clinics have a make-up specialist who can give you advice on the best way to cover up scars.
We have more information about follow-up after treatment for melanoma and recurrent melanoma.
Follow-up
After surgery you will usually have a follow-up appointment with your doctor or nurse. They will check your wound and explain if you need any further treatment. They will also give you information about checking your skin and how to stay safe in the sun.
If you had a melanoma in situ (stage 0) you will not need any further appointments. If you have further questions or are worried about new symptoms, your GP can help. If needed they will arrange for you to see a specialist again.
If you had a thicker melanoma that has not spread (stage 1 or 2) you may have ongoing follow up appointments. Some people will also have a regular scans or ultrasounds of the nearby lymph nodes. Your doctor or nurse will explain what to expect.
About our information
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References
Below is a sample of the sources used in our melanoma information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
Michielin O, van Akkooi ACJ, Ascierto PA, et al. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2019; 30, 12, 1884-1901 [accessed May 2022].
Michielin O, van Akkooi ACJ, Ascierto PA, et al. ESMO consensus conference recommendations on the management of locoregional melanoma: under the auspices of the ESMO Guidelines Committee. Annals of Oncology. 2020; 31, 11, 1449-1461 [accessed May 2022].
Peach H, Board R, Cook M, et al. Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: A UK consensus statement. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020; 73, 1, 36-42 [accessed May 2022].
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Samra Turajlic, Consultant Medical Oncologist.
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