Melanoma Removal

Melanoma RemovalMelanoma is a cancer of melanocytes, which are cells that produce melanin, the pigment that is primarily responsible for giving skin its color. Melanoma can be found anywhere on the body where melanocytes are present.

Indications:

Melanoma removal surgery is performed to make sure all of the cancer has been removed after a skin biopsy tests positive for melanoma. In the event melanoma has spread (metastasized) from the skin to other organs, melanoma removal might also be indicated to control the cancer and determine the extent to which it has spread. The procedure to remove melanoma from the skin is often referred to as a wide-excision.

Pre-Operative Evaluation:

Before you are scheduled for any melanoma removal surgery, you should expect a detailed consultation with the surgeon discussing all of your surgical options and how surgery will be coordinated with other treatments such as radiation and immunotherapy if recommended. There are many factors that help to determine the timing and sequence of your treatment plan and your surgeon will work to explain these factors to you in developing your individualized surgical plan.
Routine blood work, chest x-ray and heart studies such as an EKG can be ordered prior to surgery based on your age and the presence of any existing medical conditions.

You may be instructed to stop taking some medications before surgery. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. For more information related to preparation for surgery click here.

Procedure: 

Wide-Excision of Melanoma is usually performed under a general anesthesia, so you will not feel anything. The procedure itself is performed through an incision made over the location of the melanoma after local anesthesia (numbing medicine) has been injected in the area. The tumor along with some of the surrounding healthy tissue will be removed. The amount of healthy tissue, or margins, removed in addition to the tumor will depend upon the thickness and location of the tumor. Once tissue removal is complete, the incision will be meticulously closed with suture the majority of the time. The suture will be removed at the post op visit if required after surgery. Larger excisions may require skin grafting or creation of skin flaps to close the exposed area.

Additional procedures may be performed at the time of the wide-excision. Please keep in mind that each patient situation is different, which is why our highly trained and experienced surgeons are here to guide you through these complex decisions.

Information about additional procedures is also shared here:

Lymph Node Removal, also called a Sentinel Node Biopsy, may be recommended at the same time as the wide-excision to determine if the cancer has spread. The lymph node biopsy is usually performed if there are no concerns about enlarged lymph nodes before your surgery.

In order to identify the lymph node(s) a radioactive and/or blue dye must be injected into the area of the tumor or the skin just above the tumor. This dye will travel to the sentinel node(s) allowing your surgeon to identify and remove them. These lymph node clusters are most commonly in the axilla (armpit) and groin.  At that point a small incision will be made to remove the first one or two nodes into which a tumor drains (sentinel nodes). Once removed, the incision will be meticulously closed with suture. The suture will all be under the skin, so there will be no stitches to remove after surgery. The nodes are then sent to be tested for cancer.

If no cancer is present, no further lymph nodes need to be removed. If cancer is present, the surgeon will discuss options such as further lymph node removal or observation with or without additional treatments such as immunotherapy.

Lymph Node Dissection may be recommended if a previous lymph node biopsy shows signs of cancer. During this procedure your surgeon will make an incision to remove a number of lymph nodes most commonly located in the axilla (armpit) or groin. Once removed, the incision will be meticulously closed with suture. The suture will all be under the skin, so there will be no stitches to remove after surgery. A drain may be placed. If so, drain care instructions are attached here for your reference. The lymph node dissection may require an inpatient hospital stay depending upon the required procedure.

lymph node biopsy

Recovery: 

This varies from patient to patient and depending upon the location of the melanoma. You may have lifting and activity restrictions after surgery.

While recovery instructions may be tailored to individualize a plan of care based upon your specific needs, these instructions are common following melanoma removal surgery:

  • You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home.
  • When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.
  • Avoid fried foods, milk products and citrus juices for around one day after your surgery. Suggestions for foods to eat include soup, sandwich, pasta, potatoes, toast, and applesauce.
  • You may be able to shower within a couple of days after your surgery. If a drain is placed, you can reference the drain care instructions attached.
  • The dressings applied to your surgical site will be specific to your procedure. If surgical glue is used, there will be no dressings to remove. If bandages are applied, they can usually be removed at home in 24-48 hours. You will receive care instructions specific to your procedure.
  • You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Often times we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.
  • It is often suggested to start taking a stool softener twice daily the day following your procedure. You will want to continue this regimen as long as you are taking narcotic pain medications.

For additional information for after surgery preparation click here.

To Schedule an Appointment

To find out more about Melanoma Removal Procedures offered at CSA Surgical Center in Columbia, Missouri please call Columbia Surgical Associates at 573-443-8773 and schedule an appointment with a board-certified general surgeon.