Melanoma surgery represents the primary treatment for localized skin cancer, focusing on the complete removal of the tumor. The procedure involves excising the cancerous lesion along with a specific margin of healthy surrounding tissue to ensure all malignant cells are cleared. The duration of the operation itself is just one part of the patient’s day, with the overall time commitment depending heavily on the specific technique used.
Procedure Timelines Based on Surgery Type
The actual time spent with the surgeon, often called the “knife-to-knife” time, varies significantly based on the technique required to remove the melanoma. The most common procedure for early-stage melanoma is a Wide Local Excision (WLE), which involves removing a pre-determined margin of skin around the biopsy scar. A standard WLE performed under local anesthesia in an outpatient setting typically takes between 60 to 90 minutes to complete, which includes the time needed for meticulous wound closure.
For melanomas on the face, ears, or other sensitive areas, Mohs micrographic surgery may be used to preserve healthy tissue. Mohs is a staged procedure where the surgeon removes a layer of tissue, which is immediately processed and examined under a microscope while the patient waits. This microscopic analysis ensures clear margins before the wound is closed, making the total surgical process highly variable. It often takes three to four hours or longer depending on the number of stages required, as each stage adds an hour or more to the overall procedure time.
Factors That Influence Surgical Duration
The estimated surgical times are flexible and can lengthen or shorten based on several characteristics specific to the melanoma and its location. The Breslow thickness, the measurement of how deep the melanoma has invaded the skin, directly influences the required surgical margin. A deeper lesion necessitates a wider and deeper excision, which requires more time to remove and close the resulting defect.
The anatomical location of the lesion is another significant factor, as areas with limited skin laxity or complex structures require greater surgical precision. Operations on the hands, feet, or scalp demand more careful dissection and closure than those on the torso or limbs. Furthermore, the method of wound closure impacts duration; a simple linear closure is quick, but larger defects may require a complex skin flap or a skin graft, substantially increasing the operating room time. An additional procedure, such as a Sentinel Lymph Node Biopsy (SLNB), also extends the operation. This involves identifying and removing the first lymph node that drains the tumor site, often adding 30 minutes or more to the WLE.
Total Time Spent at the Facility
The total time a patient is committed to the hospital or surgical center is always longer than the operation itself, especially if general anesthesia is utilized. Pre-operative preparation, including check-in, meeting the surgical team, signing consent forms, and marking the surgical site, typically requires one to two hours. This phase also involves the placement of an intravenous line and consultation with the anesthesiologist.
Following the procedure, patients are moved to the Post-Anesthesia Care Unit (PACU) or a recovery room for observation. This recovery period is necessary to ensure stable vital signs and full recovery from any sedation or general anesthesia, often lasting between one and three hours. Considering all these steps, a patient undergoing a one-hour WLE with SLNB under general anesthesia should plan for a total facility commitment of four to six hours before being cleared for discharge.
Immediate Post-Procedure Care and Next Steps
Once discharged, the immediate focus shifts to meticulous wound management and pain control at home. Patients are typically instructed to keep the dressing dry for the first 24 to 48 hours, with showering permitted after that period, though soaking the wound in a bath or pool is restricted for two to four weeks. Pain following the procedure is usually managed effectively with over-the-counter pain medication like acetaminophen, with stronger prescription pain relievers reserved for more extensive operations.
Activity restrictions are important for optimal wound healing and preventing the incision from separating. Surgeons typically advise against heavy lifting (anything over 10 pounds) for up to four weeks to avoid putting tension on the sutures. Driving is prohibited for at least 24 hours following any general anesthesia or while taking prescribed narcotic pain medication. The final step is the first post-operative appointment, usually scheduled one to three weeks out, for the removal of sutures and to discuss the final pathology report confirming clear surgical margins.