Melanoma that is found early (stages 0–II or localised melanoma) can generally be treated successfully with surgery. If the melanoma has spread to nearby lymph nodes or tissues (stage III or regional melanoma), treatment may also include removing lymph nodes and additional (adjuvant) treatments.
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Surgery to remove the mole is the main treatment for early melanoma, and it can also be the only treatment you need.
Wide local excision
Even though the excision biopsy to diagnose melanoma often removes the melanoma, a doctor or surgeon may also do a procedure called wide local excision. This means removing more normal-looking skin from around the melanoma (wider margin), which reduces the risk of it coming back at that site.
A pathologist will check the tissue around the melanoma for cancer cells. If the sample doesn't contain any cancer cells, it is called a clear margin. If the margins aren't clear, you may need further surgery. Most people recover quickly after a wide local excision to remove a melanoma, but you will need to keep the wound clean.
Repairing the wound
Most people will be able to have the wound closed with stitches. You will have a scar, but this will become less noticeable with time.
If a large area of skin is removed, the wound may be too big to close with stitches. In this case, the surgeon may repair it using skin from another part of your body, which can be done in two ways:
- Skin flap – nearby skin and fatty tissue are lifted and moved over the wound from the edges and stitched.
- Skin graft – a layer of skin is taken from another part of your body (usually the thigh or neck) and placed over the area where the melanoma was removed.
The decision about whether to do a skin flap or graft 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. After several days, it will be checked to see if the wound is healing properly. If you had a skin graft, you will also have dressings on any area that had skin removed.
Surgery for melanoma often leaves a scar, which will usually fade with time. You may worry about how the scar looks, especially if it’s on your face. Various cosmetics, hairstyles and clothing can help cover scarring.
Look Good Feel Better is a national program that helps people manage the appearance related effects of cancer treatment.
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Removing lymph nodes
Many people with early melanoma will not need to have any lymph nodes removed.
In some cases, you may have a sentinel lymph node biopsy at the same time as the wide local excision. This removes the first lymph node that melanoma may have spread to. If melanoma is found, you will have regular imaging scans to check that it has not come back or spread. You may also be offered drug therapy to reduce the risk of the melanoma returning.
Occasionally, melanoma may spread to lymph nodes and cause lumps that your doctor can feel during a physical examination. If a fine needle biopsy confirms that a lymph node contains melanoma, that group of lymph nodes may be removed in an operation called a lymph node dissection or lymphadenectomy. This is performed under a general anaesthetic and requires a longer stay in hospital.
Side effects of lymph node dissection
Having your lymph nodes removed can cause side effects, such as:
- Wound pain – Most people will have some pain after the operation, which usually improves as the wound heals. For some people, the pain may be ongoing, especially if lymph nodes were removed from the neck.
- Neck/should/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.
- Seroma/lymphocele – 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 is drained by having a needle inserted into the fluid-filled cavity after surgery.
- Lymphoedema – If lymph nodes have been surgically removed, your neck, arm or leg may swell.
How to manage lymphoedema
Although lymphoedema may be permanent, it can usually be managed, especially if treated at the earliest sign of swelling or heaviness.
- Keep the skin healthy and unbroken to reduce the risk of infection.
- Wear a professionally fitted compression garment if recommended by your doctor or lymphoedema practitioner.
- Always wear gloves for gardening, outdoor work and housework.
- Moisturise your skin daily to prevent dry, irritated skin.
- Protect your skin from the sun.
- Don't pick or bite your nails, or cut your cuticles.
- Try to avoid scratches from pets, insect bites, thorns, or pricking your fingers.
- Do regular exercise to help the lymph fluid flow, such as swimming, bike riding or yoga.
- Massage the affected area to help move lymph fluid.
- Avoid having blood taken or blood pressure done on the arm on the affected side.
- Visit the Australasian Lymphology Association to find a lymphoedema practitioner or ask your doctor for a referral.
- If your skin feels swollen or hot, see your doctor as soon as possible as these may be signs of infection.
Learn more about lymphoedema
If there's a risk that the melanoma could come back (recur) after surgery, other treatments are sometimes used. These are known as adjuvant (or additional) treatment. They may be used alone or together.
Some treatments enter the bloodstream and travel throughout the body. This is known as systemic treatment, and includes:
- Immunotherapy – drugs that help the body's immune system to recognise and fight some types of cancer cells
- Targeted therapy – drugs that attack specific features within cancer cells known as molecular targets to stop the cancer growing and spreading.
In some cases, people may be offered radiation therapy, which is the use of targeted radiation to damage or kill cancer cells. Chemotherapy is rarely used for melanoma because immunotherapy and targeted therapy drugs usually work better.
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Expert content reviewers:
A/Prof Robyn Saw, Surgical Oncologist, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, NSW; Craig Brewer, Consumer; Prof Bryan Burmeister, Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD; Tamara Dawson, Consumer, Melanoma & Skin Cancer Advocacy Network; Prof Georgina Long, Co-Medical Director, Melanoma Institute Australia, and Chair, Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, NSW; A/Prof Alexander Menzies, Medical Oncologist, Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Paige Preston, Chair, Cancer Council’s National Skin Cancer Committee, Cancer Council Australia; Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland Diamantina Institute, and Director, Dermatology Department, Princess Alexandra Hospital, QLD; Julie Teraci, Clinical Nurse Consultant and Coordinator, WA Kirkbride Melanoma Advisory Service, WA.
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The information on this webpage was adapted from Understanding Melanoma - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in July 2021.