Surgical Removal of Melanoma

Steven C. Immerman, M.D., FACS © 2000

About melanoma
Melanoma is a term used to describe a certain type of skin cancer. This type of skin cancer does have the ability to spread elsewhere in the body and must be treated aggressively when it is first discovered. Unfortunately, radiation and chemotherapy are not particularly effective against melanoma, so surgery is the main treatment.

The initial treatment is to remove the skin around the original mole in such a way that we are sure that we have removed the entire original melanoma. To do this we remove a very generous amount of skin around the original spot. The exact amount depends on many factors, including the size of the original melanoma and the location on the body. Sometimes a skin graft is necessary to cover the defect left by the removal. This kind of removal will leave some change in appearance after the operation has healed, particularly if a skin graft is used. How noticeable this is will depend upon the size of the excision and the location. However, it must be kept in mind that the goal of this procedure is to obtain control of the melanoma, which can be a life threatening problem.

About the operation
This kind of procedure is done in an operating room in a hospital or surgery center. This may be done as an inpatient or an outpatient depending upon the extent of the operation and the location on the body. The type of anesthetic may also vary depending upon the exact procedure. The operation can take anywhere from one to two hours. The area around the site of the melanoma is marked and the skin and underlying fat removed. The defect is either sewn together or a skin graft is placed. The donor site for the skin graft is often on the thigh.

Occasionally, we have to insert a drain, which is a small silicone (clear plastic) tube under the skin after the operation. This will  drain any blood or serum that can accumulate in the postoperative period. These need to stay in place until they are no longer draining a significant amount of fluid. This can take anywhere from five to fourteen days.

The specimen will be sent to the laboratory, where the pathologist will examine everything that was removed. It will take him a few days to process everything, and look at it under the microscope. It is unusual for the pathologist to actually find any residual melanoma in the specimen.