What is surgery and what is it used for?

If your melanoma comes back to the original site or close to it, you may have surgery to treat it. This is called a local excision.

A local excision is usually done under local anaesthetic. You may have general anaesthetic if more tissue needs to be removed. The wound can normally be stitched together and your nurse will tell you how to look after it. You will have a scar, but this will become less noticeable in time.

If the wound is too big to stitch, you may need a skin graft. This is when a layer of skin is taken from another part of the body to mend the wound.

A skin flap is thicker than a skin graft and is used when more skin is taken. Skin flap surgery is specialised so you may have to travel to a different hospital and be treated by a plastic surgeon.

You may have to adjust to a change in your appearance. You can talk about this to your hospital team, someone close to you or a trained counsellor.

Surgery for recurrent melanoma

If your melanoma comes back at the original site or very close to it, you may be able to have surgery to remove it. This is called a local excision.

You will probably have the surgery under a local anaesthetic in the day surgery unit. Some people may have a general anaesthetic, depending on how much tissue needs to be removed.

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 to 14 days later, depending on where the melanoma was. You will have a scar, which is usually small and becomes less noticeable with time. Sometimes, 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.


Skin grafts

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 is taken depends on the size of the area to be covered. Your doctor or specialist nurse will tell you more about this.

The donor site

You will 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.

The grafted area

The grafted area may be secured with stitches. You will 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 five to seven days. The area will look red and swollen to begin with, but eventually it will heal and the redness will fade.

After skin graft surgery

After a skin graft, you can usually 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 surgery. You will need to allow the graft to heal properly. The grafted area will be quite fragile. It is 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 has 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 to 14 days after your operation. Some people may have stitches that dissolve and do not 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.


Skin flaps

A skin flap is a slightly thicker layer of skin than a graft. It is 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 is moved over the wound and stitched in place. If you have a skin flap, you may need to stay in hospital for a few days.

Skin flap surgery is very specialised. It is 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.

With scars, it obviously takes time. But it’s something to embrace and be proud of, because it’s part of who you are now. And it shows how far you’ve come.

Olivia


Coping with a change in your appearance

Depending on your surgery, you may have some small scars. Or you may have larger areas of skin that look different. Some scars may be more visible, for example if they are on your face.

People cope with changes in appearance differently. Some people may not be upset by them. Others find these changes harder to cope with or feel self-conscious. It is not always related to the size or visibility of the change. A small, hidden scar can still affect a person’s confidence. Everyone is different.

Give yourself time to get used to the changes. You may find you feel better about them after a while. Scars will also become less noticeable as time goes on.

Some skin clinics have a make-up specialist who can advise you on the best way to cover up scars. There are also organisations that provide camouflage make-up to cover up.

If you are finding things difficult, it is important to get support. You may find it helps to talk to your hospital team, someone close to you or a trained counsellor. We have a list of organisations you could contact for help.

Back to Surgery explained

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.

What happens after surgery?

You’ll be monitored very closely after your operation. You will be very tired so it’s important to rest and look after yourself.