Surgery
Surgery is the first step of treatment for the majority of melanomas, and often the only treatment necessary. It is also used for lymph node evaluation and dissection, as well as the management of advanced melanoma.
Sentinel Lymph Node (SLNB) etc.
Wide Local Excision
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Purpose: To remove any cancerous tissue that may remain after the biopsy |
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What is it? |
Side Effects |
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Standard surgical procedure for melanoma in situ, Stage I, Stage II and most Stage III melanomas.
The surgeon removes the tumor, including the biopsy site, as well as a surrounding area of normal-appearing skin and underlying subcutaneous tissue, to make certain the whole tumor has been removed.
The width of the margin taken depends upon the thickness of the primary tumor (how deeply the tumour has penetrated the skin).
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Surgery for primary melanoma involves the removal of skin, which will leave a scar. The size and appearance of the scar depends on a number of factors:
The size and thickness of the tumor
The location of the tumour on the body
Whether, when healing, there is a tendency to develop raised scars called keloids |
Skin Grafting
| Purpose: To repair the skin where the tumor has been removed, to restore it to its normal appearance |
| What is it? | Side Effects |
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A procedure, usually performed by a plastic surgeon, where skin from another part of the body is used to cover the site of the surgical removal of the tumor. The skin used to cover the incision is usually taken from areas that are hidden and covered with clothing.
Due to improved current surgical techniques, grafting can usually be avoided. Less than 10% of patients with primary melanoma require a skin graft. |
Skin grafting increases the risk of bleeding, graft failure, infection, poor healing, altered sensation, altered hair growth or contraction of the graft leading to decreased mobility. |
Good News
Recent advances in surgery allow surgeons to take narrower margins than ever before, so a much greater amount of normal skin is preserved. Most surgeons today follow the guidelines adopted and recommended by the National Institutes of Health and the World Health Organization Melanoma Program, based on large randomized, controlled trials.
The guidelines describe how much normal skin must be taken from along the margin of the tumor, based on the size of the tumor and the stage of melanoma:
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Stage of Melanoma |
Size of Margin |
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Melanoma in Situ (Stage 0) |
0.5 centimeter (less than 0.25 inch) |
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Stage 1A and primary tumors of Stage III based on their thickness-1 millimeter (mm) or less |
1 cm (about 0.375 inch) |
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Stages 1B, IIA, IIB and primary tumors of Stage III based on their thickness-1.1mm-3.99mm |
2 cm (about 0.75 inch to 1.5 inches) |
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Stage IIC and primary tumors of Stage III based on their thickness-tumours greater than 4 mm |
2-4 cm (about 0.75 inch to 1.5 inches) |
Sentinel Lymph Node (SLNB) etc.
| Purpose: The sentinel lymph node is removed for evaluation because of all the lymph nodes, it is the most likely to contain melanoma. Lymphatic mapping is used to guide the lymph node biopsy. |
| What is it? | Side Effects |
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Sentinel lymph node biopsy (SLNB) is surgery in which only the sentinel lymph node(s) - the very first lymph node (or nodes) to receive drainage from an area - is identified and biopsied. SLNB is often conducted in conjunction with lymphatic mapping, in which blue dye is injected into the skin around the tumor, along with a small amount of radioactive substance. The dye gives the surgeon a visual reference. |
A small group of patients may:
Develop a lymphocele, a pocket of lymph that builds up at the site where the lymph node was removed
Develop lymphedema and increased risk of infection (described below). The blue dye that is injected during lymphatic mapping may leave a discoloration at the injection site that may not go away. |
Lymph Node Dissection
| Purpose: To prevent local symptoms from the disease, such as pain, and to hopefully interrupt the spread of the disease to distant sites. |
| What is it? | Side Effects |
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Surgery to remove all regional lymph nodes from the area where cancerous lymph nodes were found.
TLND (therapeutic lymph node dissection) is performed if the lymph nodes closest to the primary melanoma feel enlarged, and a fine needle biopsy or excisional biopsy finds melanoma in a node or nodes.
CLND (complete lymph node dissection) is usually performed if the nodes are not enlarged, but a SLNB is performed and it shows that there is cancer in one or more nodes.
It is not clear that lymph node dissection can prevent further spread of the disease. A large worldwide study is now underway to determine this. |
Lymphedema is a swelling caused by a buildup of lymph that may not go away . Each part of the body is associated with a specific group of lymph nodes. Lymph nodes in the groin help drain lymph from the leg, nodes in the underarm help drain the arm and nodes in the neck help drain the head. When these nodes are removed, lymph may build up beyond the site of lymph node surgery and cause swelling of the subcutaneous tissues.
Increased risk of infection because it is harder for the body to fight infection in an area where nearby lymph nodes removed. It will be important to protect your arms or legs from cuts, scratches, bruises or burns that may lead to infection. If you do develop an infection, contact your doctor immediately. |
Surgery for Advanced Melanoma
| Purpose: Generally used to relieve symptoms. Sometimes, if completely resectable (e.g., solitary sites), resection will permit use of adjuvant therapy to prolong survival. |
Removal of cancerous tumors that have spread to other locations in the body Typically involves the removal of solitary masses or tumors of uncertain origin. Normal risks associated with surgery. Site-specific risks may vary, for example, surgery for brain metastases may harm normal parts of the brain and cause neurological problems.
What is it?
Side Effects
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