Melanoma is a type of skin cancer originating from pigment-producing cells called melanocytes. Surgical removal is the primary treatment approach. Early detection is beneficial, increasing the chances of successful treatment. When identified early, melanoma is often more responsive to treatment, with a five-year survival rate of 99% for thin melanomas that have not spread.
Understanding Surgical Excision
Wide local excision is the most frequent surgical method for melanoma removal. This procedure begins with local anesthetic to numb the area, ensuring patient comfort. The surgeon removes the melanoma along with a surrounding margin of healthy skin and underlying subcutaneous tissue.
A margin of healthy tissue is taken to ensure all cancerous cells are removed, minimizing local recurrence. The margin size varies, determined by the melanoma’s thickness and stage, specifically the Breslow thickness, which indicates how deeply the tumor has penetrated the skin. For instance, melanoma in situ might require a margin of 0.5 to 1.0 cm, while thicker melanomas may require margins of 1.0 to 2.0 cm.
Before definitive wide local excision, a biopsy is performed to confirm the melanoma diagnosis and determine its characteristics. This initial biopsy involves excising the suspicious lesion with a minimal margin, usually 1 to 3 mm, under local anesthesia. After the definitive excision, the wound is usually closed with stitches or clips, known as primary closure.
Specialized Removal Techniques
Beyond wide local excision, specialized techniques are also used, such as Mohs micrographic surgery. This method involves removing thin layers of skin containing the tumor, one at a time. Each layer is immediately examined under a microscope while the patient waits.
The process continues until no cancer cells are observed in the removed tissue layers. This meticulous removal allows for precise removal of cancerous cells while preserving as much healthy tissue as possible. Mohs surgery is considered for melanomas in cosmetically sensitive areas, such as the face, or for recurrent melanomas where tissue preservation is a priority. This technique helps minimize scarring and maintain function in delicate areas.
Ensuring Complete Removal
After surgical removal, the excised tissue is sent to a pathologist for microscopic examination. This examination determines if the melanoma has been completely removed. A key objective is to confirm “clear margins.”
Clear margins mean no cancer cells are detected at the edges of the removed tissue, indicating the entire tumor and a healthy border have been successfully extracted. Achieving clear margins is important for preventing melanoma recurrence at the surgical site. If pathological examination reveals margins are not clear, further surgery may be necessary to remove any remaining cancerous tissue. This aims to achieve complete eradication.
What to Expect After Removal
Following melanoma removal, proper wound care is important for healing. Patients receive instructions on how to change dressings and keep the surgical site clean to prevent infection. Pain management is addressed with over-the-counter pain relievers, though stronger medication may be prescribed depending on the surgery’s extent.
Activity restrictions may be advised for a period to allow the wound to heal properly, especially if the surgical site is in an area prone to movement. Scarring is expected after any surgical removal, and its appearance can vary based on the excised area’s size and location. Patients are also educated on signs of infection (e.g., increased redness, swelling, warmth, or pus) and advised to contact their healthcare provider if these symptoms occur.
Regular follow-up appointments with a dermatologist or oncologist are standard post-removal care. These appointments are for ongoing monitoring, including full-body skin checks, to detect recurrence or new melanomas. Long-term surveillance helps ensure continued skin health and allows for prompt intervention if new concerns arise.