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Types of surgery for melanoma

Surgery is the main treatment for melanoma. Most early melanomas are cured with surgery.

You may have

• Surgery to remove the melanoma
• Surgery to remove lymph nodes
• Surgery to remove melanoma that has spread to other parts of the body

Surgery to remove the melanoma

Doctors diagnose melanoma by removing a mole or abnormal area of skin. When you are diagnosed with melanoma, your doctor will ask you to go into hospital for another operation to take away more of the tissue in the area where the melanoma was. This is a wide local excision.

You may have the wide local excision under local anaesthetic. Sometimes the surgeon will talk to you about doing an optional test called a sentinel node biopsy at the same time as the wide local excision.  This test checks whether melanoma cells have spread into the nearby lymph nodes. If you choose to have a sentinel node biopsy you have a general anaesthetic.

Surgery to nearby lymph nodes

If melanoma has spread into the lymph nodes close to the melanoma you will probably need to have surgery to remove all the lymph nodes in that area. This can be a big operation. It is called lymph node dissection. The surgery will depend on which part of the body the lymph nodes are in.

Surgery for melanoma that has spread

Surgeons can sometimes remove melanomas that have spread to other areas of the body. This is called metastasectomy. If all the metastases can be removed it is called a complete metastasectomy. After this type of surgery people can sometimes stay well for months or perhaps years afterwards.

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Types of surgery for melanoma

Surgery is the main treatment for melanoma. Doctors usually remove the melanoma and check how deeply it has gone into the skin. Most early melanomas are cured with surgery. 

If melanoma has spread into the lymph nodes close to the melanoma you may have surgery to remove the lymph nodes. 

If the melanoma comes back some time after the surgery, you may have a further operation to remove it.

Surgery is also sometimes used to remove melanoma that has spread to other parts of the body but this is not common.

This page has information about

  • Surgery to remove the melanoma
  • Surgery to remove melanoma in the lymph nodes
  • Surgery to remove melanoma that has spread to other parts of the body

 

 

Surgery to remove the melanoma

Doctors diagnose melanoma by removing a mole or abnormal area of skin. Most melanomas are only in the upper layers of the skin when they are diagnosed and most of them are cured with surgery. 

When you are diagnosed with melanoma, your doctor will ask you to go into hospital for another operation to take away more of the tissue in the area where the melanoma was. This aims to remove any abnormal cells that may have been left behind in the area close to the melanoma. It reduces the chance of the melanoma coming back in the future and is called a wide local excision.

Wide local excision

Your doctor will remove skin and tissue from the area around the melanoma, usually down to the level of the muscle. How much tissue they take will depend on

  • Whether any of the melanoma cells were left behind in the surrounding skin
  • How deeply the melanoma has grown into the tissue beneath the skin
  • The position of the melanoma on the body
  • Whether the surgery will affect your movement afterwards (for example, if the melanoma is close to a joint)

Generally, this is a small operation. The doctor will put in stitches to close up the area where they remove the tissue. This will feel a little tight at first. But as it heals, the surrounding skin will stretch and the tightness should ease. You usually have a wide local excision under local anaesthetic. 

Sometimes your surgeon will talk to you about a test to check the nearby lymph nodes. You can choose whether or not to have this test. It is called a sentinel node biopsy. This test checks whether melanoma cells have spread into nearby lymph nodes. It gives the doctor information about the risk of your melanoma spreading to other parts of the body. It is a small operation that you have at the same time as the wide local excision. If you choose to have it you will have both the sentinel node biopsy and wide local excision under a general anaesthetic. 

Read more about sentinel lymph node biopsy

Skin graft

For some melanomas, doctors need to remove a large area of skin. If this is the case, you may need to have a skin graft to repair it. This means taking a thin sheet of skin from somewhere else on your body (the donor site) and placing it over the area that has been removed. 

The donor skin is usually taken from somewhere where it will not be too obvious, such as your inner thigh. At first it looks like a large graze. The skin will grow back quite quickly, usually over a couple of weeks.

The skin graft will be very delicate while it heals. It is vital that the graft is not damaged during this time. You must be very careful not to knock it. And your doctor and nurses will be very careful that your wound does not become infected. You may have antibiotics to take, to help prevent this. Most people having a wide local excision do not need a skin graft. The area heals up perfectly well without one.

 

Surgery to remove lymph nodes

If melanoma has spread into the lymph nodes close to the melanoma you may have surgery to remove them. So, if for example your melanoma is on your arm, the surgeon removes the lymph nodes under your arm on that side of the body. This is where the melanoma cells are most likely to spread. This operation is called a lymph node dissection.

Read about lymph nodes and the lymphatic system.

Deciding about surgery

There are different ways to see whether the melanoma has spread to the lymph nodes. This is important because it may affect the decision about whether you have the operation to remove all the lymph nodes.

The doctor may diagnose that melanoma has spread to your lymph nodes after

• A  physical examination shows your lymph nodes feel abnormally large or hard
• A scan shows that lymph nodes appear abnormal
• A sentinel node biopsy finds melanoma cells in your lymph nodes

Read about tests to check the lymph glands.

If your lymph nodes look or feel abnormal

The doctors usually take a sample of tissue (biopsy) from lymph nodes that feel enlarged or abnormal, or appear abnormal on a scan. This test is called a fine needle aspiration (FNA) or a core biopsy. The doctor may do this test in the clinic. Or a doctor may do it when you are having a scan. If the biopsy shows melanoma in a node or nodes, the doctors usually offer you an operation to remove all of the lymph nodes in that area.

The operation

The operation to remove all the lymph nodes close to your melanoma can be a big operation. The surgery you have will depend on which part of the body the lymph nodes are in. For example, if a melanoma on the arm spreads to nearby lymph nodes, those lymph nodes are in the armpit. So surgery involves removing the lymph nodes in the armpit. Your specialist will tell you more about the operation and how long you may be in hospital.

Having all the lymph nodes removed can cause some long term side effects. Lymph nodes drain fluid from your arms and legs. If the surgeon removes the lymph nodes, fluid can build up and cause swelling in your arms or legs. This is called lymphoedema.  Your doctor and nurses will tell you how you can reduce your chance of getting lymphoedema.

Read more about lymphoedema.

If a sentinel node biopsy shows melanoma in your lymph nodes

Sometimes people don’t have enlarged lymph nodes. But a sentinel node biopsy shows that there is melanoma in the sentinel lymph node, when the doctor examines the lymph node under a microscope. The sentinel node is one or more lymph nodes closest to the melanoma. A sentinel node biopsy is when the surgeon removes this lymph node (or group of nodes) and examines it under a microscope to see if there are any cancer cells in it.

If the node(s) contains melanoma cells it is called a positive sentinel node biopsy.  

Read more about sentinel node biopsy.  

Benefits and disadvantages of lymph node removal after a positive sentinel node biopsy

At the moment, it is still unclear how useful it is to remove all the remaining lymph nodes if the sentinel node contains cancer cells.

The National Institute for Health and Care Excellence (NICE) has produced guidelines about the diagnosis and treatment of melanoma. They list some advantages and disadvantages of this operation for people with a positive sentinel node biopsy. These are described below.

You can talk to your doctor about the operation. They can help you decide what to do.

Possible advantages of removing the rest of the lymph nodes are

• It is less likely that melanoma will come back in the lymph nodes close to the melanoma in the future
• It is safer and less complicated than waiting and removing them if melanoma develops in the rest of the lymph nodes
• After you have this operation you may be able to take part in clinical trials looking at new treatments. You may not be able to take part in these trials if you have not had these lymph nodes removed

Possible disadvantages of removing the rest of the lymph nodes are

• You might develop long term swelling called lymphoedema – this is more likely if the lymph nodes are in your groin than in other parts of the body
• Melanoma may not develop in the remaining lymph nodes, so there is a chance that it has been unnecessary to remove them –  we know that  melanoma develops in the remaining lymph nodes in 1 out of every 5 people who don’t have them removed
• Any operation can cause complications

Read more about this on the National Institute for Health and Care Excellence website

To help you make a decision about your treatment, there is also a website that provides a tool called an option grid. These grids provide information about different treatment options, to help people make decisions. You can look at the option grids website. You need to log in to use this website. You can find the option grids for lymph node removal (lymphadenectomy) under 'M' for melanoma. 

 

Surgery to remove melanoma that has spread to other parts of the body

You may have surgery to remove tumours that have spread to other areas of the body. This is called metastasectomy. The operation you have depends on which part of the body the melanoma is in. 

It is most commonly used when people have a secondary melanoma tumour in the skin. If all the metastases can be removed it is called a complete metastasectomy. It can't cure the melanoma but after this type of surgery some people can stay well for months or sometimes years afterwards. 

 

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Updated: 12 February 2016