Types of surgery for melanoma

The types of surgery include:

• Wide local excision. This surgery is done to remove all of the melanoma and some normal tissue around it. This can help keep the melanoma from growing back. The surgery takes place after a biopsy to confirm the diagnosis of melanoma. The biopsy results also help the healthcare provider decide how much tissue needs to be removed in the surgery. The surgery usually is done with local anesthesia, which numbs the area. If your provider needs to remove a lot of skin, you may need a skin graft. For a graft, the surgeon takes skin from another part of your body to replace the skin that was removed. The surgeon typically uses stitches to close small excisions. The tissue removed is sent to a pathologist. They will look under a microscope to make sure the entire melanoma was removed. If not, you may need additional surgery.

• Sentinel lymph node biopsy. You may need a sentinel lymph node biopsy if you have a thick melanoma or one with features that make it more likely to have spread. This procedure removes nearby lymph nodes to check for cancer cells. It’s done because melanoma often spreads first to the lymph nodes. In a group of lymph nodes, cancer is most likely to go to 1 or 2 lymph nodes first. These lymph nodes are called sentinel lymph nodes. During the procedure, a surgeon removes a sentinel lymph node. It’s then examined in a lab for cancer cells. If no cancer is found, the other lymph nodes in the group can be left in place. Results of a sentinel lymph node biopsy help your provider figure out what treatment you may need.

• Lymph node dissection. If lymph nodes near the melanoma are enlarged or if cancer is found in the sentinel node, you may need more surgery to remove nearby lymph nodes in the area. This surgery is known as a lymph node dissection. 

• Amputation. If the melanoma is on your finger or toe and would be hard to remove, the surgeon may suggest removing part of or all of the finger or toe. 

• Mohs Surgery. In some cases, Mohs surgery may be considered, but this varies by provider. Mohs surgery is done by a specially trained dermatologist or surgeon. The skin and melanoma is removed in very thin layers. Each layer is then looked at with a microscope. If cancer cells are seen, the surgeon removes another layer of skin. This is a slow process, sometimes taking hours, and is repeated until a layer shows no signs of cancer.

Surgery by stage of melanoma

Some surgeries work better for certain stages of melanoma. For example:

• Stage 0 or I melanoma. Wide local excision surgery is the standard treatment. The surgeon removes the tumor and some of the normal tissue around it. Without surgery, melanoma could spread to other parts of your body. For some stage I melanomas, the surgeon may advise a sentinel lymph node biopsy. If cancer is found in the sentinel lymph node, the surgeon may also remove more nearby lymph nodes (lymph node dissection).

• Stage II or III melanoma. You may first need a sentinel lymph node biopsy or a lymph node dissection. You'll also have wide local excision surgery to take out the tumor. Depending on the size of the incision and the location on your body, you may need a skin graft.

• Stage IV melanoma. Your provider may suggest surgery to remove tumors and ease symptoms caused by advanced melanoma. Complete surgical removal, if possible, of all areas of advanced melanoma may result in a cure.

Your provider will talk with you about which surgery will work best for your stage of melanoma.

Before and after surgery

Talk with your healthcare provider about what kind of surgery is the best option for you. Ask any questions and address any concerns you may have. You may still need other types of treatment before or after surgery.

Surgery is most often in a provider's office or a hospital’s outpatient clinic. You’ll be able to go home the same day. For more complex surgery, you may need to stay overnight in the hospital. 

It will take a couple of weeks for your incision to heal. During this time, you may have:

• Bruising

• Minor pain

• Redness and swelling of incision site

• Infection

• Swelling in  an arm or leg (lymphedema) after having lymph nodes removed

• Scarring

Talk with your healthcare team about what to expect. If you’ve had skin grafts, your team will tell you how to take care of them as they heal.