Removal of skin tissue that has cancerous cells called melanoma or malignant melanoma. 

 

PARTS OF THE BODY INVOLVED

Skin

REASONS FOR PROCEDURE

To treat skin cancer

RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE

  • Smoking
  • Poor nutrition
  • Recent or chronic illness
  • Use of certain medications

WHAT TO EXPECT

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam of skin
  • Blood and urine tests, possibly
  • Skin biopsy
  • Photographs

During Procedure - Anesthesia

Anesthesia - Usually local, but depends on the procedure

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:

Stage 0 -The abnormal cells are found only in the outer layer of skin and do not invade deeper tissues.

Stage I - Cancerous cells are in the outer layer of the skin (epidermis) and/or the upper part of the inner layer of skin (dermis), but have not spread to nearby lymph nodes. The tumor is less than 1.5 millimeters (1/16 inch) thick.

Stage II - The tumor is 1.5 to 4 millimeters (less than 1/6 inch) thick and has spread to the lower part of the dermis, but not into the tissue below the skin or into nearby lymph nodes.

Stage III - The tumor may be larger or smaller than 4 millimeters thick, may have spread to lower layers of the skin, may have additional tumor growths within 1 inch of the original tumor (called "satellite tumors"), may have spread to surrounding lymph nodes, and may be actively spreading to nearby areas of the body.

Stage IV - The tumor has spread to other organs or to lymph nodes far away from the original tumor.

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 10 days after surgery

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)
  • Biological therapy such as interferon (which uses the body's immune system to kill cancer cells).

After Procedure - Laboratory exam of removed tissue

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 - None. 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; you can wash it gently with mild soap
  • Your doctor may recommend applying a non-prescription antibiotic ointment to the wound before applying bandages
  • Your doctor may prescribe medication for pain or antibiotics to prevent infection
  • 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 avoiding sun, using sun block, and wearing protective clothing. Discuss with your doctor a schedule for screening your skin for a recurrence or new melanomas.

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
SOURCES:

American Cancer Society

National Cancer Institute

American Society for Dermatologic Surgery

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