Treating early melanoma

Thursday 1 January, 2015

On this page: Surgery | Removing the lymph nodes (dissection) | Adjuvant therapies | Key points


Melanoma that is found early can generally be treated successfully with surgery. Your medical team will discuss the best treatment for you based on how far the melanoma has spread.

Surgery

Surgery is the main treatment for early stage (localised) melanoma. Most of the time this is the only treatment needed.

Wide local excision

A doctor or surgeon will do a procedure called wide local excision. This means that the area where the melanoma is, as well as a small amount of surrounding normal-looking skin will be cut out. This is called a safety margin, and is done to make sure all the cancer cells have been removed. The safety margin is usually between 5 mm and 1 cm, depending on the thickness and site of the melanoma. In some circumstances, a safety margin of up to 2 cm may be advised. The surgeon will stitch the wound closed.

A wide local excision is often performed as a day procedure using local anaesthetic. However, people with a melanoma thicker than 1 mm or with a Clark level of 4 or above will generally have a sentinel node biopsy at the same time and will be given a general anaesthetic. The sentinel node biopsy is not accurate if it is performed after the wide local excision has been done.

A pathologist will check the tissue around the melanoma for cancer cells. If the sample doesn’t have any cancer cells, it is called a clear margin. If the margins aren’t clear, you may need further treatment.

Repairing the wound

Most people will be able to have the surgical wound drawn together with stitches. If the wound is too big to close with stitches, the surgeon may cover it using some skin from another part of your body. This can be done in two ways:

  • Skin flap
    Nearby skin and fatty tissue is pulled over the wound and stitched.
  • Skin graft
    A layer of skin is taken from another part of your body and placed over the area where the melanoma was removed. The skin graft is usually taken from the thigh.

The decision about whether to do a skin graft or flap will depend on many factors, such as where the melanoma is, how much tissue has been removed and your general health.

In either case, the wound will be covered with a dressing and left for several days. It will then be checked to see if it is healing properly. You will also have dressings on any area from which skin was taken for a graft.

Recovering from surgery

You may be uncomfortable for a few days after a wide local excision. Your doctor will prescribe pain-killers if necessary. If you have a skin graft, the area on which the skin is grafted may look red and raw immediately after the operation. Eventually this area will heal and the redness will fade. Your medical team will tell you how to keep the wound clean to prevent it from becoming infected. Occasionally the original skin graft doesn’t take and a new skin graft is required.

Your total recovery time will vary depending on the thickness of the melanoma and the extent of the surgery required. Most people recover in a week or two. Your doctor can also give you information about any bruising or scarring you may have after surgery.

For more information about surgery, call Cancer Council 13 11 20 for a free copy of Understanding Surgery.

"I went to a doctor who specialises in facial and cosmetic surgery. He said it was important to get the melanoma out straightaway. He cut out a larger piece – about the size of a 20-cent coin – and it had clear margins. The cuts from surgery were able to heal into the folds and wrinkles of my face, so the scar is not noticeable." - John

Removing the lymph nodes (dissection)

If the melanoma has spread to your lymph nodes, they will be removed in an operation called a lymph node dissection or lymphadenectomy. The lymph nodes you have removed are likely to be near the location of the primary melanoma. There are large groups of lymph nodes in the neck, armpits and groin.

Side effects

Like most treatments, having your lymph nodes removed can cause side effects such as:

  • Wound pain
    Most people will have some pain after the operation. This usually improves as the wound heals. Although for some people, pain may continue after the wound has healed, especially if lymph nodes were removed from the neck. Talk to you medical team about how to manage your pain.
  • Shoulder stiffness and pain
    These are the most common problems if lymph nodes in your armpit were removed. You may find that you cannot move your arm as freely as you could before the surgery. It may help to see a physiotherapist. You may also be at risk of developing lymphoedema (see below).
  • Seroma/lymphocoele
    This is a collection of fluid in the area where the lymph glands have been removed. It is a common side effect of lymphadenectomy and sometimes this fluid needs to be drained by having a needle inserted into the cavity which has filled up with fluid.
Lymphoedema

If the lymph nodes have been surgically removed from the groin or armpit area, swelling of the leg, arm or neck on the same side is the most common problem. This is called lymphoedema and happens due to a build-up of lymph fluid in the affected part of the body.

The likelihood of lymphoedema following treatment depends on the extent of the surgery and whether you’ve had radiotherapy. It can develop a few weeks, or even several years, after treatment. Though lymphoedema may be permanent, it can usually be managed.

How to manage lymphoedema
  • Keep the skin healthy and unbroken. This will reduce the risk of infection.
  • Wear a professionally fitted compression sleeve, stocking or bandaging if recommended by a physiotherapist or occupational therapist.
  • Always wear gloves for gardening and housework.
  • Avoid scratches from pets, insect bites, thorns or pricking your finger when sewing.
  • Use sunscreen to protect your skin from sunburn.
  • Moisturise your skin to prevent dryness and irritation.
  • Don’t pick or bite your nails, or push back your cuticles.
  • Do light exercise to help the lymph flow, such as swimming, bike riding or light weights.
  • Massage the affected area to help move fluid.
  • See a lymphoedema specialist – visit the Australasian Lymphology Association or talk to your doctor.
  • Seek medical help urgently if you think you may have an infection.

Adjuvant therapies

Occasionally, other treatments are used after surgery if there’s a risk that the melanoma could come back. These are known as adjuvant treatments. They may include radiotherapy, targeted therapies and immunotherapies, or you may be offered an opportunity to participate in a clinical trial.

For more information see treatment for advanced melanoma.

Key points

  • Melanoma can be treated successfully if it is diagnosed early. This is called early stage or localised melanoma.
  • Most people will only need to have the melanoma surgically removed. This usually does not require a hospital stay or further treatment.
  • Treatment is based on how far the melanoma has spread.
  • Melanomas are always surgically removed. The surgeon will cut out the melanoma and some skin around it (safety margin). This is called a wide local excision.
  • In a wide local excision, small wounds are stitched up. For larger wounds, skin is pulled over the wound and stitched (skin flap) or a thin layer of skin is taken from another part of the body, such as the thigh, and placed over the wound (skin graft).
  • Recovery time will vary depending on the extent of the surgery. Most people recover in about two weeks.
  • Melanoma that is found early can generally be treated successfully with surgery. However, if the melanoma has spread to other parts of your body, you will need further treatment.
  • If cancer has spread to nearby lymph nodes, they will be removed in a surgical procedure called lymph node dissection or lymphadenectomy. This procedure may cause side effects, such as lymphoedema.
  • Lymphoedema occurs when lymph fluid build ups and causes swelling. This can be managed.
  • Treatments that are used after surgery, in case the melanoma comes back, are called adjuvant therapies.

Reviewed by: Prof Bryan Burmeister, Director of Radiation Oncology, Princess Alexandra Hospital, QLD; Dr Victoria Atkinson, Senior Medical Oncologist, Division of Cancer Services, Princess Alexandra Hospital, QLD; Assoc Prof John Kelly, Head of Victorian Melanoma Service VIC; Dr Mark Hanikeri, Director WA Melanoma Advisory Service, Plastic and Reconstructive Surgeon, WA Plastic Surgery Centre WA; Lydia Visintin, Clinical Nurse Consultant, Melanoma Institute Australia NSW; Carol Hargreaves, 13 11 20 consultant, Cancer Council NSW; Julie Fraser, Peer Support Volunteer, Cancer Council QLD ; Susanna Cramb, Viertel Cancer Research Centre, Cancer Council QLD.

Updated: 01 Jan, 2015