Surgery for melanoma
Most people will have surgery after their biopsy. This is to remove more skin tissue from the area. It’s known as a wide local excision and makes sure that there are no melanoma cells left behind.
Very occasionally, if enough normal (non-cancerous) tissue was taken away when your melanoma was removed, you may not need to have a wide local excision.
Skin cancer nurse specialist talks through the treatment of melanoma and we hear from Jessica who was diagnosed with a malignant melanoma.
Before surgery, the specialist will examine your lymph nodes. This is because the most common place for melanoma cells to spread is to the lymph nodes closest to the melanoma.
Your specialist will check whether they look or feel swollen. If the melanoma is on your leg, they’ll examine the lymph nodes behind your knee and in your groin. If it’s on your chest, back or abdomen, they’ll check the lymph nodes in your groin, armpits, above the collarbones and in the neck.
If any of these lymph nodes are swollen, or your specialist thinks there is a possibility your melanoma may have spread to them, they will suggest you have tests to check your lymph nodes. Some people may be offered a test to check their lymph nodes even if they aren’t swollen. This test is done at the same time as the surgery and is known as a sentinel lymph node biopsy.
Stage 1 melanomas rarely spread to the lymph nodes, so you won’t usually need tests to check them.
During a wide local excision, the surgeon removes an amount of normal-looking tissue from all around the area where the melanoma was, including underneath it. This is known as a margin. It’s done to make sure that no melanoma cells have been left behind.
The amount of skin that’s removed will depend on how far the melanoma has grown into the deeper layers of the skin. Your specialist will let you know how much skin will be removed. You’ll usually have the wide local excision under a local anaesthetic in the day surgery unit. It may sometimes be done under a general anaesthetic.
The wound can usually be stitched together. Your specialist nurse will talk to you about how to look after the wound area. It will look red and sore at first, but this will gradually get better. Your stitches will be removed 5–14 days later, depending on where the melanoma was. You’ll be left with a scar, which is usually small and becomes less noticeable with time. Occasionally, the wound may be too big to stitch together. In this case, you may need to have a skin graft or a skin flap to mend the wound (see below).
A skin graft is a layer of skin taken from another part of the body and placed over the area where the melanoma was removed. The place where the skin is taken from is known as the donor site. The place where it is moved to is called the grafted area. The amount of skin that’s taken depends on the area to be covered. Your doctor or specialist nurse will tell you more about this.
The grafted area
The grafted area may be secured with stitches. You’ll have a dressing over it, which will be left in place while the graft heals. The skin graft will connect with the blood supply in the area. This usually takes 5–7 days. It will look red and swollen to begin with, but eventually it will heal and the redness will fade.
The donor site
You’ll have a dressing on the donor site to protect it from infection. How long the site takes to heal will depend on how much skin was removed. If skin was taken from the thigh, buttock or upper arm, it may take up to two weeks to heal. If it was taken from the neck, behind the ears or the inner side of the upper arm, it may only take about five days to heal. The donor site can often feel more uncomfortable than the grafted area. You may need to take regular painkillers for a while.
After skin graft surgery
After a skin graft, it’s usually possible to go home on the same day. Some people need a short stay in hospital depending on where the graft is and how big it is.
Try not to do too much during the first couple of weeks after your skin graft. You’ll need to allow the graft to heal properly. The grafted area will be quite fragile, so it’s important not to put pressure on it, or rub or brush against it. Some people may need to take some time off work until it’s healed. If you have children, you may need some extra help at home until you feel able to do the things you normally do.
Your stitches will be removed 5–14 days after your operation. Some people may have stitches that dissolve and don’t need to be removed.
Both the grafted and donor areas will develop scars. These should gradually become less noticeable. There will also be some difference between the grafted skin and the skin surrounding it. This will lessen over time. Your hospital team can tell you more about what to expect.
A skin flap is a slightly thicker layer of skin than a graft. It’s taken from an area very close to where the melanoma was. The flap is cut away but left partially connected so it still has a blood supply. It’s moved over the wound and stitched in place. If you have a skin flap, you may need to stay in hospital for up to four days.
Skin flap surgery is very specialised. It’s usually done by a plastic surgeon. You may have to travel to a different hospital to have it. If you need a skin flap, your doctor will be able to tell you more about it.
Depending on your surgery, you may have some scars. We have more information about coping with a change in appearance on our life after melanoma page.