Surgery for advanced melanoma
Surgery can sometimes be used to help control the growth of advanced melanoma and relieve symptoms, but usually only when it hasn’t spread very much.
It can be used to treat melanoma that has spread to:
areas of skin distant from the original melanoma
lymph nodes distant from the original melanoma
other areas of the body, including the liver and the lungs (if the cancer has only spread to a single place in that area of the body).
Surgery can be used to remove a melanoma that has spread to the skin and that causes new lumps (nodules) to appear. Sometimes these may bleed or cause discomfort. Nodules can often be removed with a simple operation. This can be done under a local or general anaesthetic, depending on the amount of skin that’s being removed.
You can have your operation as an outpatient or you may need an overnight stay in hospital. Occasionally people may need to have skin taken from somewhere else in the body to replace the skin that’s removed (a skin graft). Your surgeon or specialist nurse will explain more about this.
Your stitches will be removed about a week after surgery, unless you have dissolvable stitches. You may need to have your wound cleaned and dressed until it’s healed. The hospital nurses can show you how to do this, or they can arrange for a district nurse to do it for you at home.
If melanoma spreads to distant lymph nodes, one or more lymph nodes may become enlarged or feel hard. If this is uncomfortable or painful, you may have an operation to remove the nodes. The operation will be done under a general anaesthetic, and you’ll probably be in hospital for a few days. The kind of operation you’ll have will depend on where the lymph nodes are. Your surgeon or specialist nurse will tell you more about what to expect.
After the operation, you may have a small tube called a drain to remove any fluid that builds up around your wound. The drain is connected to a small suction bottle. The drain will be removed when most of the excess fluid has been drained away, usually within a few days. The wound will be covered with a dressing and your stitches or staples will be removed 7-10 days later, unless they are dissolvable. District nurses can visit you at home and clean and dress your wound, if needed.
After the lymph nodes have been removed, there’s a risk that you could develop swelling in an arm or leg (or another part of the body). If this does happen, it will be on the same side that the lymph nodes were removed from. This is called lymphoedema.
If scans show that there is only one secondary tumour in the brain and no other secondary melanomas in the body, it may be possible to remove it with surgery. To begin with, you will usually be referred to a specialist surgeon (a neurosurgeon) to see whether an operation is possible. This type of surgery will be carried out in a specialist centre. Your brain surgeon and specialist nurse will tell you what to expect before and after your operation. You’ll probably be in hospital for at least a week.
Steroids are drugs that are usually given to help reduce any swelling around the tumour and improve your symptoms. You’ll probably be prescribed these before your operation and for a few weeks afterwards, depending on your symptoms. Some people may be given radiotherapy after their surgery.
Other parts of the body
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If the melanoma has spread to a single area of the liver or lungs and there isn’t any melanoma elsewhere in the body, it may be possible to remove the tumour with surgery. However, this is major surgery and it’s not often possible. You will usually be referred to a specialist surgeon who will assess you to find out whether an operation is suitable for you.