Treatment for early melanoma

Sunday 1 January, 2017

On this page: Surgery | Removing the lymph nodesAdjuvant treatments | Sam's story | Key points


Melanoma that is found early (stages 0–2 or localised melanoma) can generally be treated successfully with surgery. Tests such as CT or PET scans are not usually recommended for early melanoma. If the melanoma has spread to nearby lymph nodes or tissues (stage 3 or regional melanoma), treatment may also include removal of the lymph nodes and adjuvant treatments.

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 (removal). 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 wider or safety margin. Removing more tissue around the melanoma than was cut out during the excision biopsy reduces the risk of it coming back (recurring) locally. The safety margin is usually between 5 mm and 1 cm, depending on the type, thickness and site of the melanoma. For thicker tumours, a wider margin of up to 2 cm may be advised.

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 surgery to remove wider margins, or other treatments.

A wide local excision is often performed as a day procedure using local anaesthetic. This means you can go home soon after the surgery, provided there are no complications. People with a melanoma thicker than 1 mm will often have a sentinel node biopsy at the same time and will be given a general anaesthetic. The sentinel node biopsy may be less accurate if it is performed after the wide local excision has been done.

Repairing the wound

Most people will be able to have the surgical wound drawn together with stitches. When large skin cancers are removed, the wound may be 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 are moved 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 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 that had skin removed for a graft.

Recovering from surgery

You may be uncomfortable for a few days after a wide local excision. Your doctor will prescribe painkillers 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 flap or graft doesn’t take and a new one 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 bleeding, bruising, scarring or numbness you may have after surgery.

See more information about surgery or call Cancer Council 13 11 20.

"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

If the sentinel lymph node biopsy showed that the melanoma has spread to your lymph nodes (regional melanoma), they will be removed in an operation called a lymph node dissection or lymphadenectomy. This is performed under a general anaesthetic and requires a stay in hospital. 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. For some people, however, pain may continue after the wound has healed, especially if lymph nodes were removed from the neck. Talk to your medical team about how to manage your pain.
  • Neck/shoulder/hip stiffness and pain – These are the most common problems if lymph nodes in your neck, armpit or groin were removed. You may find that you cannot move the affected area as freely as you could before the surgery. It may help to see a physiotherapist.
  • 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 lymph node surgery. Sometimes this fluid needs to be drained by having a needle inserted into the fluid-filled cavity.
Lymphoedema

If lymph nodes have been surgically removed, swelling of the neck, arm or leg is the most common problem that can occur. Occasionally it can affect the breast tissues. This is called lymphoedema and it 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 that has damaged your lymph nodes. It can develop a few weeks, or even several years, after treatment. Although lymphoedema may be permanent, it can usually be managed.

How to prevent and/or manage lymphoedema
  • Keep the skin healthy and unbroken. This will reduce the risk of infection.
  • Wear a professionally fitted compression garment if recommended by a physiotherapist or occupational therapist.
  • Always wear gloves for gardening, outdoor work and housework.
  • Moisturise your skin daily to prevent dry, irritated skin.
  • Use sunscreen to protect your skin from sunburn.
  • Don’t pick or bite your nails, or push back your cuticles.
  • Avoid scratches from pets, insect bites, thorns, or pricking your fingers.
  • 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 practitioner – talk to your doctor or visit Australasian Lymphology Association.
  • Seek medical help urgently if you think you may have an infection.

Adjuvant therapies

If there’s a risk that the melanoma could come back (recur), other treatments are sometimes used after surgery to try to reduce that risk. These are known as adjuvant (or additional) therapies. They may include:

  • radiotherapy – the use of x-rays to damage or kill cancer cells (also known as radiation therapy)
  • targeted therapy – the use of drugs to attack particular gene mutations that allow cancers to grow and spread
  • immunotherapy – the use of drugs to stimulate the body’s immune system to recognise and fight some types of cancer cells.

For further information about radiotherapy, targeted therapy and immunotherapy, see treatment for advanced melanoma.

You may also be offered an opportunity to participate in a clinical trial.

Sam’s story

"I have always had a lot of freckles and noticed that one on my calf had changed – it was bleeding, itching, and had become darker. Although I asked my friends “What do you think this is?” I put off doing anything about it for a few weeks.

"As I live in a country town, I had some difficulty getting an appointment with a local skin specialist, so made an appointment to see him in Sydney. He removed the suspicious spot the same day.

"I was really shocked and scared when the specialist called to say it was a melanoma. I was only 23 and I had no idea what would happen next.

"The surgeon I was referred to found that the cancer had spread to my lymph nodes, and I had all the lymph nodes in my left leg removed. A month after the lymph nodes were removed I felt very unwell and had a rash.

"I didn’t know what was wrong and ended up hospitalised with an attack of cellulitis in my leg. I had a second attack of cellulitis shortly afterwards. After my surgery I participated in a clinical trial. I still have to deal with mild lymphoedema and some scarring from the surgery, and have regular check-ups with my doctor.

"Connecting with others through social media really helped me deal with my feelings of isolation. It was difficult being treated in Sydney away from home, but sharing my story with others helped me to open up doors and build relationships.

"I found the whole experience very overwhelming, but now have a new appreciation for life. I place a lot of importance on healthy eating, being active and staying out of the sun. I’m more aware of my own body and the need to get any changes checked out straightaway."

Tell your cancer story.

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.
  • Melanoma is always surgically removed in a procedure called a wide local excision. The surgeon will cut out the melanoma and some skin around it (wider or safety margin).
  • 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 and placed over the wound (skin graft).
  • Recovery time will vary depending on the extent of the surgery. Most people recover in one to two weeks.
  • If cancer has spread to nearby lymph nodes, this is called regional melanoma.
  • Lymph nodes are removed in a surgical procedure called lymph node dissection or lymphadenectomy. This procedure may cause side effects, such as shoulder, neck or hip stiffness and lymphoedema.
  • Lymphoedema occurs when lymph fluid builds up and causes swelling. This can be prevented or managed.
  • Treatments that are used after surgery, in case the melanoma comes back, are called adjuvant therapies.

Reviewed by: Prof Brendon J Coventry, Associate Professor of Surgery, University of Adelaide, Surgical Oncologist, Royal Adelaide Hospital, and Research Director, Australian Melanoma Research Foundation, SA; A/Prof Victoria Atkinson, Senior Medical Oncologist, Princess Alexandria Hospital and Greenslopes Private Hospital, QLD; Prof Diona Damian, Dermatologist, University of Sydney at Royal Prince Alfred Hospital, and Melanoma Institute Australia, NSW; Sharon Dei Rocini, Consumer; Prof Gerald Fogarty, Director, Radiation Oncology, St Vincent’s Hospital, NSW; Chantal Gebbie, 13 11 20 Consultant, Cancer Council NSW; Miklos Pohl OAM, Plastic and Reconstructive Surgeon, Peter MacCallum Cancer Centre and Epworth Healthcare, VIC; Julie Teraci, Clinical Nurse Consultant, Western Australian Melanoma Advisory Service, St John of God Subiaco Hospital, WA.

Updated: 01 Jan, 2017