Surgery for Melanoma

All melanomas need to be removed by a procedure known as a wide excision. This means the surgeon also removes a relatively large border, or margin, of healthy-looking skin around the tumor. The size of the margin of normal skin removed during the wide excision depends on the thickness of the melanoma.

For example, for melanomas less than 1 millimeter thick, a 1-centimeter margin of normal skin surrounding the tumor or the biopsy scar is removed to make sure no cancer cells remain. In general, melanomas thicker than 1 millimeter require the removal of a 2-centimeter margin of healthy tissue. Our doctors can determine what type of anesthesia is best to ensure your comfort throughout the procedure.

If cancer is found in the lymph nodes during a biopsy, your doctor may need to remove additional nodes with surgery performed under general anesthesia. This can be done at the same time as a wide excision to avoid multiple procedures. A dermatopathologist then examines the nodes under a microscope to see if they contain melanoma cells. Knowing how many lymph nodes contain cancer helps guide treatment.

Our surgeons can close small and medium incisions by suturing the edges of skin together, usually with a number of layers of stitches. Large incisions for tumors that are thicker or bigger in diameter may need to be repaired with special reconstructive techniques.

Our doctors, including plastic surgeons and reconstructive plastic surgeons, specialize in repairing defects created by the melanoma and its removal in all areas of the body, even cosmetically sensitive areas such as the face, using techniques that help reduce scarring. This approach may be possible even for larger tumors, depending on their location on the face. Our surgeons are specially trained to achieve the best possible functional and cosmetic results.

Doctors also perform reconstructive surgery on the arms and legs. They use techniques that help prevent contracture, a tightening of a joint that results from hardening in the muscles, tendons, ligaments, and other surrounding tissues. These techniques preserve flexibility and minimize scarring.

The surgical approach to reconstruction depends on the tumor location and how much surrounding tissue was removed. For a broad, shallow area of skin that needs to be repaired, doctors may use a skin graft, or a small portion of the top layers of healthy skin, from a less visible area of your body, such as the upper thigh.

To close a larger or deeper opening of the skin, doctors may use a local flap—a piece of nearby skin that can include underlying fat and muscle. The flap may be moved, along with its blood vessels, to the site that requires repair. Cartilage, the firm, white tissue that helps give structure to parts of the body such as the ears and nose, may also be moved during reconstruction.

Skin flaps are often left in place for several weeks as the surgical site heals. In a second surgery, they are contoured to match the appearance of the surrounding healthy skin and tissues. For example, areas of the nose can be repaired with a local skin flap from the cheek and cartilage from the ear. Doctors perform another surgery to remove any extra flap tissue and reconstruct the shape of the nose with minimal scarring to the face.

After you heal, if a scar becomes raised or red, doctors can inject the area with steroids, which may help to flatten the tissue and remove the redness. Lasers can help treat discoloration.

Recovery time from melanoma surgery depends on the size of the tumor, whether you need one or several lymph nodes removed, and whether you have reconstruction. Our doctors closely monitor you after surgery to ensure you are healing properly. They also help to manage any discomfort with medications or Perlmutter Cancer Center’s integrative health services.