Surgery for melanoma skin cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body.

Most people with melanoma skin cancer will have surgery. The type of surgery you have depends mainly on where the cancer is and the risk that it will come back (recur). When planning surgery, your healthcare team will also consider other factors, such as your age, your overall heath and how surgery will affect how you look.

Surgery may be the only treatment you have or it may be used along with other cancer treatments. You may have surgery to:

• completely remove the tumour
• remove lymph nodes
• repair or rebuild the area where the cancer was removed
• reduce pain or ease symptoms (called palliative surgery)

The following types of surgery are commonly used to treat melanoma.

Wide local excision removes the cancer along with some normal tissue around it (called the surgical margin). Doctors mainly use wide local excision to treat early-stage and locoregional melanomas. It may be the only treatment needed for early-stage melanoma. Wide local excision may also be used to treat melanoma that has come back in the same area where it started (called a local recurrence) or spread to other nearby areas of skin (called satellite tumours).

The size of the surgical margin increases with the thickness of the tumour. The following are recommendations used by surgeons for the size of surgical margin when doing a wide local excision of melanoma. Sometimes a smaller surgical margin than recommended may be used for thick tumours on the head or neck.

Sometimes part or all of a finger or toe needs to be removed (amputated) to make sure all the cancer is removed. Whether or not amputation is needed or not depends on where the cancer is on the finger or toe and how deep it has grown into the skin and other tissue.

For a wide local excision, a local anesthetic is used to freeze or numb the area. The doctor uses a surgical knife (scalpel) to cut the tumour out of the skin. The area is closed using stitches. The tissue removed is sent to a lab to make sure there are no cancer cells in the surgical margin, which means that all the cancer has been removed.

A sentinel lymph node biopsy (SLNB) finds and removes the first lymph node (or first few lymph nodes) in a group of lymph nodes to see if it contains cancer cells. It is normally done right before the wide local excision. It is mainly done to help stage the cancer and decide if more treatment would be helpful.

An SLNB may be done if a melanoma is more than 1 mm thick. Doctors may also consider doing an SLNB for slightly thinner tumours (0.8 mm to 1 mm thick) or very thin tumours (less than 0.8 mm thick) if they have high-risk features. High-risk features include if the skin over the tumour is broken with an open wound (called ulceration) or if the cancer cells are dividing rapidly (called a high mitotic rate).

Find out more about a sentinel lymph node biopsy (SLNB).

A complete lymph node dissection is surgery to remove an entire group of lymph nodes. It can be done at the same time as a wide local excision or during a second surgery. It is usually done if the doctor feels any enlarged lymph nodes and imaging tests show that lymph nodes contain cancer cells.

Melanoma usually spreads to lymph nodes closest to where it started (called the nodal basin or lymphatic basin). The type of complete lymph node dissection done depends on which and how many lymph nodes contain cancer. This may include the following:

• neck dissection to remove lymph nodes from the neck
• axillary lymph node dissection to remove lymph nodes from under the arm (armpit)
• inguinal lymph node dissection to remove lymph nodes from the groin
• pelvic lymph node dissection to remove lymph nodes from the pelvis or deep in the groin

A complete lymph node dissection is done under a general anesthetic in a hospital operating room. The surgeon makes a cut through the skin to remove the lymph nodes. Other nearby tissue may also be removed.

Find out more about a lymph node dissection.

Surgery may be needed to help improve how the skin looks after surgery to remove the tumour.

A skin graft may be done if a large area of skin was removed. The surgeon removes skin from another area of the body and places it over the surgical area to cover the open wound and repair the skin. If the surgical wound is small, the surgeon may rotate a nearby piece of skin to cover the open wound.

A skin flap is a thick piece of tissue with its own blood supply. Like a skin graft, a skin flap covers the area where the cancer was removed. A skin flap can be used to repair large wounds on the face.

Surgery may be done to treat metastatic melanoma if it has only spread to:

• 1 or a few small areas on or just under the skin
• a lung, the liver, the brain or the small intestine

The type of surgery done will depend on which organ the cancer has spread to. Surgery for metastases is often called surgical excision or resection.

Find out more about metastatic cancer.

Side effects of surgery will depend mainly on the type of surgery, where on the body the surgery is done and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for melanoma may cause these side effects:

• pain, which is often managed with pain medicines
• scarring
• bruising
• changes to skin colour
• wound infection
• numbness
• poor healing
• lymphedema( after a lymph node dissection)

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.