Surgical Procedures: Surgery and Staging for Malignant Melanoma of the Skin

Skin is made up of many layers and cell types. These include squamous cells, basal cells, and melanocytes. Melanocytes help with skin pigmentation (coloring). Melanocytes that become cancerous are called malignant melanoma. Malignant melanoma (also called “melanoma”) can affect the skin, eyes, and the lining of the gut.

This article will focus on melanoma that starts in the skin or mucous membranes.

What is staging and how is it done?

Staging looks at the size of the tumor, where it is, and if it has spread to other organs. It also helps figure out what treatment is best. Melanoma spreads to other parts of the body through the tissue, lymph, and blood systems. Your provider will have you get a few tests to figure out the stage of your cancer and if it has spread. For melanoma, these tests may be:

Physical Exam: This is a general exam to look at your body and to talk about past health issues. A thorough skin exam will be done.

Biopsy: A biopsy takes cells from the cancer to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample under a microscope in a laboratory. There are many types of biopsy, such as:

• Punch biopsy: A skin sample is taken by pressing a circular blade into the skin around the affected area.
• Excisional biopsy: The whole lesion and a small amount of normal-looking skin around the lesion are removed.
• Incisional biopsy: The most irregular appearing portion of the mole is removed.
• Sentinel Lymph Node Biopsy: Blue dye is injected near the cancerous tumor. Any lymph nodes with blue dye present are removed and tested for cancer.

Imaging: Radiology tests can look inside your body at the cancer and see if it has spread. These tests can include:

• X-rays.
• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).

Blood Tests: Your blood may be tested to check for high levels of lactate dehydrogenase (LDH).

The stage of melanoma is determined by looking at things like tumor thickness (using the Breslow scale), if there is tumor ulceration (breakdown of skin on top of the tumor), and if it has spread to the lymph nodes or other parts of the body (referred to as metastasis). The stages of melanoma include stage 0 (melanoma-in-situ) through stage IV (4) disease.

Surgical Procedures Used in the Treatment of Melanoma

Surgery is often used to treat melanoma. The procedure used depends on many things, like the size and location of the cancer. Your care team will talk to you about your procedure. 

 Surgical procedures used to treat melanoma include:

Wide Local Excision: The melanoma is removed, as well as some nearby normal-looking tissue. In some cases, a skin graft will be used to close the wound. With a graft, skin from another part of the body is used to close the wound.

Mohs Surgery: The melanoma lesion is removed. Layers of skin are then removed and looked at under a microscope right away to check for cancer. The surgeon will stop removing layers once cancer cells are no longer seen.

Lymphadenectomy: Removal of lymph nodes that may be affected by melanoma.

If the melanoma has spread to other parts of the body, like the lymph nodes, lungs, gastrointestinal tract, bone or brain, other surgeries may be needed. Your provider will talk to you about your treatment plan.

What are the risks of melanoma skin cancer surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Infection.
• Bleeding.
• Scarring.
• Skin graft rejection.
• Nerve damage.
• Cancer recurrence (cancer coming back).
• Being unable to remove all of the cancer.

What is recovery like?

Recovery from surgery and changes to activity level depend on the type of procedure you had. Your team will tell you when to return to the office for suture (stitch) removal, about any medications you need to take, and how to care for any dressings (bandages) you may have.

Contact your healthcare team if you have:

• Fever or chills.
• Redness, swelling, pain, bleeding, or drainage from your incision.
• Any new or worsening pain.
• A new opening of your incision or sutures.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that you can go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.