Read about having surgery to remove melanoma skin cancer.
When you have surgery
Surgery is the main treatment for melanoma. You might have surgery to:
- remove an early stage melanoma
- remove the lymph nodes close to the melanoma if the cancer has spread there
- remove melanoma that has come back in the same place following an operation
- remove melanoma that has spread to other parts of the body
Surgery to remove more tissue (wide local excision)
Doctors usually diagnose melanoma by removing the abnormal mole and a small area of surrounding skin. The doctor sends this tissue to the laboratory to check if it is a melanoma and how deep it is.
You usually have a second operation if you are diagnosed with a melanoma. This is called a wide local excision. The doctor removes a larger area of healthy skin and tissue from around where the melanoma was.
How much tissue you have removed depends 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)
In the latest guidelines, the National Institute for Health and Care Excellence (NICE) recommend that:
- for stage 1 melanoma, the surgeon removes at least 1 cm of tissue around the melanoma
- for stage 2 melanoma, the surgeon removes at least 2 cm of tissue around the melanoma
Generally, this is a small operation. You usually have it as an outpatient, under local anaesthetic.
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 might need a general anaesthetic if the doctor needs to:
- check your lymph nodes (sentinel node biopsy)
- remove a large area of skin and you need to have a skin graft
Sometimes your doctor needs to remove a large area of skin. You might have a skin graft to help repair it.
For a skin graft, you have a thin sheet of skin removed from somewhere else on your body (the donor site). The surgeon then places it over the area where the melanoma 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 is very delicate while it heals. It is vital that the graft is not damaged during this time. Try not to knock it. You might have antibiotics to help prevent an infection.
Most people who have a wide local excision do not need a skin graft. The area heals up well without one.
Checking your lymph nodes
If you have stage 1B or stage 2 melanoma your doctor will talk to you about whether you want to have a test to check your lymph nodes. This is called a sentinel lymph node biopsy (SLNB).
It is a small operation that you have at the same time as the wide local excision. You have it under general anaesthetic.
Surgery to remove lymph nodes
You might have surgery to remove the lymph nodes close to the melanoma if cancer has spread there.
At your first follow up appointment, your doctor:
- gives you the results of the surgery
- examines you
- asks how you are and if you've had any problems
This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says.
How often you have follow up appointments depends on the results of your surgery. Ask your doctor how often you need to have check ups and what they will involve.
Surgery to remove melanoma that has spread
You might have surgery to remove melanoma that has spread to other areas of the body. This spread is called secondary or a metastases. The operation you have depends on which part of the body the melanoma is in.
For example, you might have surgery to remove a secondary melanoma tumour in the skin. Or it might be possible for some people to have an operation to remove a secondary melanoma in their lung. This operation is more likely if there are no other signs of melanoma elsewhere in the body. And you need to be reasonably fit and well to have this operation.
It is not usually possible to cure the melanoma. But some people can stay well for months or sometimes years after surgery to remove a secondary.