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Melanoma: Surgery

Melanoma: Surgery

Surgery is the most common way to treat melanoma. It’s a common treatment for all stages of melanoma. Surgery is done to remove any area that has melanoma cancer cells. Surgery may be done by a specialist such as a:

  • Dermatologist

  • General surgeon

  • Plastic surgeon

  • Cancer surgeon 

Types of surgery for melanoma

  • Sentinel node biopsy. If you have a thick melanoma or one with more signs of disease, you may need a sentinel lymph node biopsy. 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 one or two 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 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 doctor determine 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, more surgery may be needed to remove nearby lymph nodes in the area. This surgery is known as a lymph node dissection. 

  • Wide local excision. This surgery is done to remove all of the melanoma, and some normal tissue around it. This can help prevent the melanoma from growing back. The surgery takes place after a biopsy. The biopsy results help the doctor decide how much tissue needs to be removed in the surgery. The surgery is done with anesthesia. This may be local anesthesia, to numb the area. If your doctor 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 doctor uses stitches to close small excisions. 

  • Amputation. If the melanoma is on your finger or toe, the doctor may suggest removing part of or all of the finger or toe. 

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 nearby lymph nodes.

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

  • Stage IV melanoma. Your doctor may suggest surgery to remove tumors and ease symptoms caused by advanced melanoma. This is palliative therapy, meaning it gives relief but doesn't cure the cancer.

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

Before and after surgery

Talk with your doctor about what kind of surgery is an 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 doctor'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, called lymphedema, after having lymph nodes removed

  • Scarring

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