A wide local excision removes more tissue from the area where the mole was. The aim is to remove all the melanoma cells. This reduces the chance of the melanoma coming back.
The amount of skin that is removed depends on how far the melanoma has grown into the deeper layers of the skin. Your cancer doctor will talk to you about how much skin needs to be removed.
You usually have a wide local excision under a local anaesthetic, in a day surgery unit. This means you are awake but you do not feel anything. You will have an injection to numb the area where the operation is done. A WLE is sometimes done under a general anaesthetic. This means you are asleep during the operation.
You may have tests to check the lymph nodes at the same time as a wide local excision. This depends on the size of the melanoma and whether your lymph nodes look or feel swollen. The test is called a sentinel lymph node biopsy.
Your surgeon can usually stitch the wound together. It will look red and might be swollen at first, but this will gradually get better. You will be given painkillers to help after the operation.
Your specialist nurse will talk to you about how to look after the wound area. A nurse will remove your stitches 5 to 14 days after your operation. You can arrange this with your practice or district nurse, or it may happen at your outpatient appointment.
If the wound is too big to stitch together, you may need to have a skin graft or a skin flap.
You will have a scar after the operation. It is usually small, but it depends on the amount of tissue that was removed. To begin with, your scar will be red if you have white skin, or darker if you have dark skin. It will fade over time. Everyone’s skin heals differently. If you have dark skin or fair, freckled skin, scars may be more noticeable for longer.
A skin graft is a layer of skin that is 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 called 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.
The donor site
After the layer of skin is removed, you have a dressing on the donor site to protect it from infection. How long the area takes to heal depends 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 layer of skin may be stitched to the grafted area. You have a dressing over it, which is be left in place while the graft heals. The skin graft connects with the blood supply in the area. This usually takes 5 to 7 days. The grafted area may look red or darker than usual to begin with. It may also be swollen. As it slowly heals, any changes fade and the swelling goes down.
After a skin graft, you can usually go home on the same day. Or you may need a short stay in hospital, depending on where the graft is and how big it is. Try not to do too much in the first two weeks after surgery. It is important not to put pressure on the grafted area such as rubbing or brushing against it. A nurse will remove your stitches 5 to 14 days after your operation. Or you may have stitches that dissolve and do not need to be removed.
You will have a scar in both the grafted area and donor site. There will also be some differences between the grafted skin and the skin surrounding it, but this will become less noticeable over time.
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 removed. A surgeon cuts the flap away, but leaves it partly connected, so it still has a blood supply. They then move the flap over the wound and stitch it 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 and 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 surgeon can tell you more about it.
If all the melanoma cells are removed during your wide local excision, you will not need any more treatment.
Tests to check the lymph nodes may show melanoma cells in the lymph nodes. In this situation you may be offered further surgery to remove all the nearby lymph nodes. Your cancer doctor will talk to you about whether this may be helpful in your situation.
Depending on your surgery, you may have some small scars or areas of skin that look different. Changes to your appearance may make you worried about your body image. Some skin clinics have a make-up specialist who can give you advice on the best way to cover up scars. The British Association of Skin Camouflage provides camouflage make-up to cover up scars.