TESTS AND PROCEDURES

Melanoma Removal Surgery

January 03, 2018

Melanoma Removal Surgery

Skin layers with melanoma showing incision lines to remove tumor.

Melanoma is a type of skin cancer. It often starts as a mole or dark spot on the skin. It spreads faster than many other types of cancer. And it can be fatal if not treated. Melanoma is often diagnosed with a biopsy. This is the removal of the abnormal skin area to be looked at under a microscope. Once a diagnosis is made, typically a larger area around the melanoma is also removed. This is called a wide local excision. If the cancer is caught early, it has a high chance of being cured.

Removing lymph nodes

Lymph nodes are small masses of tissue that are part of the body’s immune system. If melanoma spreads, it often goes to nearby lymph nodes first.

The sentinel node is the first lymph node tumor cells travel into. It’s the first place that cancer is likely to spread. Depending on the thickness of your tumor, the sentinel node may need to be removed and checked for cancer cells. A sentinel node biopsy is a test often done during melanoma removal surgery. This helps the healthcare provider know which lymph nodes to remove. If you will have a sentinel node biopsy, your healthcare provider can tell you more about what to expect.

If you have nearby lymph nodes that are enlarged on an imaging test such as a CT scan or can be felt during an exam, your healthcare provider will likely do a needle biopsy to see if they contain melanoma cells. If they do, the healthcare provider might remove all of the lymph nodes in this area. This is known as a lymph node dissection.

Risks and complications

Risks and possible complications include:

  • Bleeding

  • Infection

  • Scarring at the surgery site

  • Problems with the skin graft 

  • Failure to remove all of the cancer, requiring further treatments

  • Risks of anesthesia

  • Fluid build-up and swelling in an arm or leg (lymphedema) if many lymph nodes were removed

Preparing for surgery

Prepare for the surgery as you’ve been told. In addition:

  • Tell your healthcare provider about all medicines you take. This includes over-the-counter medicines, herbs and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.

  • If you are having general anesthesia, do not eat or drink during the 8 hours before your surgery, or as directed by your healthcare provider. This includes coffee, water, gum, and mints. (If you have been instructed to take medicines, take them with a small sip of water.)

  • If you’re having a sentinel node biopsy, you may have an injection of harmless dye the day before surgery.

The day of surgery

The surgery may take up to several hours, depending on what is done. You will likely go home the same day.

Before the surgery begins:

  • An IV (intravenous) line is put into a vein in your arm or hand. This line supplies fluids and medicines.

  • You will be given medicine to keep you pain free during surgery. This may be general anesthesia, which puts you into a deep sleep. A tube may be inserted into your throat to help you breathe. Or you may have sedation, which makes you relaxed and sleepy. If you have sedation, local anesthesia will be injected to numb the area being worked on. If the surgery is done to remove a smaller skin tumor, you might just need local anesthesia. The anesthesiologist will discuss your options with you.

During the surgery:

  • If you’re having a sentinel node biopsy, harmless blue dye is injected to help the healthcare provider locate lymph nodes where cancer may have spread.

  • An incision is made at the tumor site. The tumor is removed along with some of the normal tissue around it. This helps ensure that any cancer cells that may have spread to nearby skin are removed.

  • One or more lymph nodes near the tumor may be removed. These are checked for cancer cells (a sign that cancer has spread).

  • The incision may be closed with stitches or staples. In some cases, a skin graft or flap may be needed to help close the site. This can come from your own body, a donor, or manmade sources. The healthcare provider will discuss the different types of grafts with you before the surgery.

After the surgery

If you had only local anesthesia, you can go home shortly after the procedure. If you had general anesthesia, you’ll be taken to a room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You’ll be given medicine to manage pain. When it’s time for you to be released from the hospital, have an adult family member or friend ready to drive you.

Recovering at home

Once at home, follow the instructions you’ve been given. Your healthcare provider will tell you when you can return to your normal routine. Be sure to:

  • Take all medicine as directed.

  • Care for your incision as instructed.

  • Don’t do heavy lifting or strenuous activities as directed.

  • Don’t drive until your healthcare provider says it’s OK. Don’t drive if you’re taking medicine that makes you sleepy or drowsy.

  • Follow your healthcare provider’s guidelines for showering. Don’t swim, take a bath, use a hot tub, or do other activities that cover the incision with water until your healthcare provider says it’s OK.

 

When to call your healthcare provider

Call your healthcare provider right away if you have any of the following:

  • Chest pain or trouble breathing (call 911

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

  • Chills

  • Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worse pain, or foul-smelling fluid

  • Pain that cannot be controlled with medicine

Follow-up

You will have follow-up visits so your healthcare provider can see how well you’re healing. If needed, stitches or staples will be removed at 1 of these visits. You and your healthcare provider can also discuss any other treatments you may need.

Updated:  

January 03, 2018

Sources:  

Evaluation and treatment of regional lymph nodes in melanoma, UpToDate, Initial surgical management of melanoma of the skin and unusual sites, UpToDate

Reviewed By:  

Alteri, Rick, MD,Lehrer, Michael Stephen, MD