Surgery for melanoma that has come back in the same area
If your melanoma comes back at or very close to the original site and it can be removed with surgery, you’ll be offered a local excision to remove it.
You’ll probably have the surgery under a local anaesthetic in the day surgery unit. This will be the same way that you had your melanoma removed before (see our section on treating melanoma with surgery). It may sometimes be done under general anaesthetic, depending on how much tissue needs to be removed.
The wound can usually be stitched together. Your specialist nurse will give you information and advice about looking after the wound area. It will look red and sore at first, but this will gradually settle. Your stitches will be removed 5-14 days after the procedure, depending on where the melanoma was. You’ll be left with a scar, which is usually small and will eventually fade.
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.
A skin graft is a layer of skin that’s taken from another part of the body and placed over the area (grafted area) where the melanoma has been removed. The place where the skin is taken from is known as the donor site (see below). The amount of skin taken depends on the area to be covered. Your doctor or specialist nurse will tell you more about what to expect.
The grafted area
The grafted area may be secured with stitches. You’ll have a dressing over the area, which will be left in place while the graft heals. The skin graft will connect with the blood supply from the area, allowing it to survive. This usually takes 5-7 days. The grafted area will look red and swollen to begin with, but eventually it will heal and the redness will fade.
The donor site
You’ll also have a dressing on the donor site to protect it from infection. The length of time the donor site takes to heal will depend on how much skin has been removed. If the donor skin has been taken from the thigh, buttock or upper arm, it may take up to two weeks to heal. If it’s been 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 area can often feel more uncomfortable than the grafted area, and 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. But you may need a short stay in hospital, depending on where the graft is and how big it is. You’ll need to take things easy for the first couple of weeks 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. Depending on where and how big your graft is, you may need to take some time off work until it’s healed. If you have young 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 of skin will develop scars, which should gradually fade. There will be some difference between the grafted skin and surrounding skin – usually this lessens over time. But some people may have scars that are more noticeable, depending on the amount of skin and tissue that’s been removed. The operation to the grafted area will leave a slightly hollowed (concave) area in the skin. Occasionally, there may be some raised scarring.
A skin flap is a slightly thicker layer of skin taken from an area very close to where the melanoma has been removed. 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 after the surgery. Skin flap surgery is very specialised, so 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.
Coping with a change in appearance
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Some people may have had a melanoma on a visible part of the body, such as the face or neck, and its removal may change their appearance. Others may be left with some scarring from the surgery. Changes in appearance can be difficult to come to terms with. Some skin clinics have a makeup specialist who can advise on the best way to cover up scars. There are also organisations that provide camouflage make-up to cover scars.
Coping with a change in how you look can be difficult. It’s important to get support and many people find it helps to talk things through with someone close or a trained counsellor. You might find it helpful to see our section on coping with body changes.