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Surgery is usually the main treatment for most types and stages of melanoma. If your tumor is in an early stage and removed using a melanoma surgical treatment, you may not need any other treatment. Other times, melanoma surgery is used together with other types of treatments.
Melanoma Care Tailored to You
You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.
Wide Surgical Excision: Melanoma
If your melanoma is localized, meaning it is just on your skin, you may need only a simple surgical excision (cutting it out). Here is information on the surgical process and how it works:
- Your physician removes the tumor, along with a portion of normal-looking skin around the tumor, called a margin. If the melanoma is thicker, your surgeon will have to cut wider margins. This is important so that the melanoma does not grow back at the original location later.
- If the surgeon did not take wide margins during your original biopsy, you may need another surgical excision to remove more skin, including very small lymph vessels near the tumor where cancer cells might have spread.
- Depending on where your melanoma is and how large the margins need to be, you might need only a local numbing medicine or you might have general anesthesia, which means you would be asleep during the procedure.
Reconstructive Melanoma Surgery
Fred Hutch’s melanoma surgeons and reconstructive surgeons work together to treat melanoma in sensitive locations, like the face or hand. The surgeon who removes the cancer may be able to close the area by bringing the edges of the skin together around the wound.
If the area is too large or the cancer went too deep for this type of melanoma surgery, our reconstructive surgeons offer more options. One is closing the wound with nearby skin that is turned into place (local tissue rearrangement). Others involve using skin from another part of your body (skin grafting) or using skin plus other tissue from another body area (free-flap reconstruction). Learn more about reconstructive surgery.
Sentinel Lymph Node Mapping and Biopsy
Thicker melanomas tend to spread to nearby lymph nodes, which need to be checked for cancer and possibly removed through a melanoma surgical procedure.
A tracer substance and a dye are injected near your tumor to find the lymph node or nodes where your cancer would spread first (sentinel nodes). Your surgeon removes only the nodes where the substance appears, and a pathologist checks the nodes in a lab for cancer cells.
- If cancer is found, your surgeon removes the lymph nodes in that area
- If cancer is not found, the rest of your lymph nodes will be left in place
Retired Fred Hutch surgeon David R. Byrd, MD, brought this technique, sentinel lymph node mapping and biopsy, to the Pacific Northwest in the 1990s.
Preventing and Treating Lymphedema
Lymphedema is swelling that develops when the lymphatic system is damaged or blocked. It is not common, but it is a possible complication of melanoma surgery. So, after any lymph node surgery, we refer our patients to physical therapists (PTs) with expertise in preventing, detecting and managing lymphedema.
We have several resources for lymphedema treatment, including PTs who provide complete decongestive therapy and specialized reconstructive surgeons who offer advanced surgical treatments, such as lymph vessel reconnection surgery and lymph-node transfer.
Why Choose Fred Hutch for Melanoma Surgery
Our skin cancer surgical team includes experts in surgical oncology, including melanoma surgery, reconstruction and head and neck surgery. This team specializes in melanoma surgical treatment, and you can feel confident knowing that the surgeon who cares for you is best suited for your specific diagnosis.
Scarring is an inevitable part of the healing process after any surgery, including melanoma surgery. At first, your scar may be red, raised and firm. Over time, it will soften, get flat and fade. The final appearance of your scar depends on many factors, including the size and location of your melanoma, your own skin and how you care for it.
To help your scar heal, it's important to keep the wound clean and moist, avoid strenuous activities that could stretch the incision and protect the area from any sun exposure.
When your melanoma is surgically removed, the goal is to get "clear margins." This means the pathologist, who examines the removed tissue under a microscope, confirms that the edges of the tissue that were removed are free of cancer.
If the pathology report shows that the margins are not clear — meaning there are still cancer cells at the edge of the removed tissue — it means that some cancer may still need to be removed. In this case, your physician will likely recommend another melanoma surgical procedure to remove more tissue from the site to ensure all cancer cells are gone.