Most patients have surgery after the biopsy; this operation is called wide local excision.
When a sufficient amount of normal (non-cancerous) tissue has been removed when the melanoma was excised, wide local excision may not be necessary.
- Wide local excision
With this procedure, a certain amount of normal-looking tissue is removed from the area where the melanoma is found, including the area under the melanoma. These are known as margins. This is done to make sure no cancer cells have been left.
The amount of skin removed will depend on the extent to which the melanoma has spread.
This is normally done with the patient under local anesthesia and in the outpatient surgery unit; however, general anesthesia is sometimes required.
- Skin grafts
A skin graft is a layer of skin taken from another part of the body and placed over the area where melanoma has been removed from. The place where the skin is taken is known as the donor site. The place where the skin is moved to is known as the graft site. The amount of skin taken will depend on the area to be covered.
- Skin flaps
A flap is a layer of skin that is slightly thicker than the graft; flaps are taken from an area located very close to the melanoma. The flap is partially resected, leaving one area connected in order to maintain blood supply. The resected part is then placed on top of the wound.
Surgery can be performed to help control the growth of advanced melanoma and to relieve symptoms, although normally this is done only in cases in which the melanoma has spread a great deal. Surgical treatment can be used to treat melanoma that has spread to:
- Parts of the skin located at a distance from the original melanoma
- Lymph nodes that are distant from the original melanoma
- The brain
- The liver
- The lungs
- Melanoma that has spread to the skin
Surgery can eliminate melanoma that has spread to the skin and may cause skin nodules to appear. These lumps can sometimes bleed or cause discomfort and often can be removed with a simple operation.
- Melanoma that has spread into the lymph nodes
If the melanoma spreads to distant lymph nodes and is uncomfortable or painful, surgery can be done to remove them. This operation is usually done with the patient under general anesthesia and requires admission.
It may be necessary to insert a small tube to remove the fluid that has accumulated around the wound. The wound is covered with a bandage and the sutures are removed a few days later.
Removal of the lymph nodes carries a risk of lymphedema, or inflammation in an arm or a leg (or another part of the body).
- Melanoma that has spread to the brain
If examinations show that there is only one secondary tumor in the brain, it may be possible to remove it surgically. Usually you will have to be hospitalized for several days.
You may be given steroids to help reduce the swelling around the tumor and make your symptoms improve. The operation is done afterward and, depending on the symptoms, radiotherapy may be administered.
- Melanoma that has spread to other parts of the body.
If the melanoma has spread to just one area in the liver or lungs and there is no melanoma in any other part of the body, it may be possible for the tumor to be surgically removed. This, however, is major surgery and is not always possible.