Melanoma Removal

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 determine if there are any metastases

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—also known as in situ melanoma, abnormal cells are found only in the outer layer of skin and do not invade deeper tissues; corresponds to Clark level I
• Stage IA—melanoma less than 1.0 mm thick without ulceration; Clark level II/III; no spread to lymph node or elsewhere
• Stage IB—melanoma less than 1.0mm thick with ulceration or Clark level IV or V; 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 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 but without ulceration 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 with 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 and has widely spread to other organs such as the brain, lung, liver, or lymph nodes

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 bodysite 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; 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.