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

Author: OncoLink Team
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The skin is made up of many layers and cell types. These include squamous cells, basal cells, and melanocytes. Melanocytes are responsible for skin pigmentation (coloring). Melanocytes that become cancerous are called malignant melanoma. Malignant melanoma (also referred to simply as 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 performed?

Staging is a way to find out if and where the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. 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, or a piece of 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, including:

  • 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-appearing skin around the lesion is removed.
  • Incisional biopsy: The most irregular appearing portion of the mole is removed.
  • Sentinel Lymph Node Biopsy: A radioactive or blue dye is injected near the cancerous tumor and allowed to absorb; any lymph nodes with blue dye or radioactive material present are removed and tested for cancer.

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

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

Melanoma spreads to other parts of the body through the tissue, lymph and blood systems. Cancer stage determines how extensive the cancer is, how far it has spread and what treatment course will be recommended. The stage of melanoma is determined by looking at factors such as tumor thickness described by the Breslow scale, presence of tumor ulceration, spread to the lymph nodes and spread to other parts of the body (referred to as metastasis). The stages of melanoma include stages 0 (melanoma-in-situ) through stage IV disease.

Surgical Procedures Used in the Treatment of Melanoma

Surgery is often used to treat melanoma. The procedure used will depend on many factors, including the size and location of the cancer. Your care team will talk to you about your specific procedure. 

There are a few common surgical procedures used to treat melanoma, depending on your particular stage and situation, including:

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

Mohs Surgery: The melanoma lesion is removed. Following removal of the lesion, layers of skin are then removed and are immediately looked at under a microscope 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, such as the lymph nodes, lungs, gastrointestinal tract, bone or brain, other surgeries may be needed. Your provider will talk to you about your specific situation. 

What are the risks associated with 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). 
  • Incomplete removal of the cancer. 

What is recovery like?

Recovery from surgery and your postoperative activity restrictions will depend on the type of procedure you have had. Your team will tell you when to return to the office for suture removal, about any medications you need to take and how to care for any dressings 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.

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