Melanoma Removal
Definition
Melanoma removal is the surgical removal of skin tissue that has cancerous cells called melanoma.
Melanoma
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What to Expect
Prior to Procedure
Depending on the stage of the disease, your doctor will likely do the following:
- Physical exam of skin
- Biopsy of any suspicious lesion
- Chest x-ray
- Blood test for lactate dehydrogenase (an enzyme)
- Imaging studies with CT scan , MRI,PET scan
- Sentinel lymph node biopsy to find out if the cancer has spread
Anesthesia
Melanoma removal typically involves local anesthesia.
Description of the Procedure
The extent of the procedure depends on the stage of the cancer. Melanoma, like other cancers, is classified according to stages. The first is clinical staging based on physical examination, results from biopsy, and imaging studies. The second is pathologic staging based on the first type plus biopsies of lymph nodes and/or other organ systems.
Under the microscope, the thickness of the melanoma is measured by a small rule with the technique called the Breslow measurement. As a general rule, melanoma with less than 1 millimeter in thickness has a very slight chance of spreading to either surrounding lymph nodes or other organs. The chance of spreading increases progressively with the degree of thickness.
A second evaluation, the Clark system, examines how deep the melanoma penetrates into the surrounding skin. The Clark scale varies from I to V with deeper melanoma having the higher numbers. If ulceration (outermost layer of skin covering missing) is seen, the prognosis of the patient is worse.
Melanoma Stages
- Stage 0 (Clark level I)—also known as in situ melanoma, abnormal cells are found only in the outer layer of skin and do not invade deeper tissues
- Stage IA (Clark level II/III)—melanoma less than 1.0 mm thick without ulceration; no spread to lymph node or elsewhere
- Stage IB (Clark level IV or V)—melanoma less than 1.0 mm thick with ulceration; or melanoma 1.01-2.0 mm thick without ulceration; no spread to lymph node or elsewhere
- Stage IIA—melanoma 1.01-2.0 mm thick with ulceration; or melanoma 2.01-4.0 mm thick without ulceration; no spread to lymph node or elsewhere
- Stage IIB—melanoma 2.01-4.0 mm thick with ulceration; or melanoma greater than 4.0 mm thick without ulceration; no spread to lymph node or elsewhere
- Stage IIIA—melanoma of any thickness without ulceration, and with 1-3 lymph nodes involved
- Stage IIIB—melanoma of any thickness without ulceration with 1-3 lymph nodes involved, and major spread to other lymph nodes
- Stage IIIC—melanoma of any thickness with ulceration, 1-3 lymph nodes involved, and major spread to other lymph nodes; or melanoma of any thickness with four or more lymph nodes involved
- Stage IV—melanoma of any thickness that has widely spread to other organs such as the brain, lung, liver, or lymph nodes
Types of Surgery
Surgical removal of the cancerous cells is the primary treatment for melanoma. The types of surgery done include:
- Simple excision—Thin melanomas can usually be completely cured with this relatively minor surgery. The tumor is cut out, along with a small amount of normal, noncancerous skin at the edges. The wound is stitched back together and usually leaves a scar.
- Wide excision—Usually done when a melanoma diagnosis has already been made. More skin is cut away from the site to make sure no more cancer cells remain in the skin.
- Amputation—If melanoma is present on a finger or toe, it may be necessary to amputate the cancerous part of that digit.
- Therapeutic lymph node dissection—If the cancer has spread to nearby lymph nodes, some of those nodes will be surgically removed for laboratory exam.
Depending on how extensive the melanoma removal proves to be, the area may be closed with stitches or may require a skin graft for repair. Stitches will be removed about 7 to 14 days after surgery depending on the site and extent of excision.
In more advanced cases of melanoma, treatments in addition to surgery may be necessary. These include:
- Chemotherapy (using drugs to kill cancer cells)
- Radiation therapy (using high-dose x-rays to kill cancer cells)
- Immunotherapy such as alpha-interferon (which uses the body's immune system to kill cancer cells)
- Biological therapy such as gene therapy, tumor vaccines, monoclonal antibodies
After Procedure
The removed tissue will be examined by a laboratory.
How Long Will It Take?
This depends on the extent of the melanoma and the type of surgery. Simple excision can take less than one hour.
Will It Hurt?
Anesthesia prevents pain during the procedure. You may have some pain around the wound during recovery, but you will be given pain medication to relieve this discomfort.
Possible Complications
- Surgical wound infection
- Incomplete removal of all cancerous cells
- Lymphedema (fluid accumulation in the lymph nodes); a possible complication of lymph node dissection
- Recurrence or spread of cancer
- Nerve damage
- Scarring
Average Hospital Stay
Melanoma removal is usually done on an outpatient basis, but this varies depending on the extent of the surgery.
Postoperative Care
- Keep the surgical area clean, dry, and protected by bandages. Wash it gently with mild soap.
- If recommended by your doctor, apply a nonprescription antibiotic ointment to the wound before applying bandages.
- If prescribed to you, take pain medication and antibiotics.
- Avoid vigorous exercise according to your doctor's recommendations.
Outcome
The wound from surgical excision should heal completely, but may leave a scar. A hard blunt ridge may form along the incision, but should recede gradually.
Talk to your doctor about appropriate ways to protect your skin against the sun, such as using sun block and wearing protective clothing. Discuss with your doctor a schedule for screening your skin.
Call Your Doctor If Any of the Following Occurs
- Signs of an infection, including fever and chills
- Redness, swelling, increased pain, excessive bleeding, or discharge from the incision site
- A new lump or discoloration in your skin, or a change (such as color, bleeding, itching, growth) in an already-existing mole, either at the surgical site or in a new location
RESOURCES:
American Academy of Dermatology
http://www.aad.org/default.htm
American Cancer Society
http://www.cancer.org
CANADIAN RESOURCES:
Canadian Cancer Society
http://www.cancer.ca
Canadian Society of Plastic Surgery
http://www.plasticsurgery.ca
References:
American Cancer Society website. Available at: http://www.cancer.org .
American Society for Dermatologic Surgery website. Available at: http://www.asds-net.org .
Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. Guidelines from the American Joint Committee on Cancer. J Clin Oncol. 2001;19:3635-48.
Lens MB, Dawes M, Goodacre T, Bishop JA. Excision margins in the treatment of primary cutaneous melanoma: a systematic review of randomized controlled trials comparing narrow vs wide excision. Arch Surg . 2002;137:1101-5.
National Cancer Institute website. Available at: http://www.cancer.gov .
Last reviewed November 2007 by Ross Zeltser, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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