Surgery for melanoma

• After a mole or affected area of skin is removed and melanoma is diagnosed, your doctors will most likely recommend further surgery, which is called wide local excision.
• Surgery is the main treatment for melanoma.
• You may need a skin graft if a large area of skin is removed.
• If there is cancer in your lymph nodes, you may have
  surgery to remove them.

• Wide local excision is surgery to remove normal-looking skin around the scar where the melanoma was removed. 
• This surgery is to reduce the risk of the melanoma coming back. 
• The amount of skin that needs to be removed depends on the thickness of the melanoma examined under the microscope (Breslow thickness).
• This surgery is normally done under local anaesthetic. Most
  melanomas treated early do not recur (come back) after wide local excision.

Skin grafts 

• Sometimes when a wider area of skin is removed, the surgeon may need to do a skin graft. A graft means that layers of skin are taken from another part of your body and placed onto the wound. 
• The skin can be taken from your thigh or upper arm. This is called the donor site. The thickness of the skin taken depends on the depth of the area to be covered.
• Once the skin is in place it is covered with a dressing. The graft ischecked after several days to make sure it is healing properly. The donor site is also checked and dressed regularly. 
• You may feel sore for a few days after the surgery, but you will be given painkillers. You might have to go back to the hospital for wound checks and dressings. 
• Don’t be put off by how the graft area looks at first. The raw look will heal and fade in time. 
• Small skin grafts can often be done as day surgery, so you can go home the same day.

Skin flaps

Sometimes a skin flap is used. This is where the surgeon takes a thick layer of skin – with its own blood supply – from an area near the melanoma site and places it over the site to repair the wound. Usually you can go home the same day.

• If a small number of melanoma cells are found in your sentinel lymph node and your staging scans are clear, the MDT may recommend adjuvant treatment without further surgery. Adjuvant treatment aims to reduce the risk of the cancer coming back.
• If melanoma is extensively found in your lymph nodes or has
  come back months to years after initial treatment and your staging scans don't show any melanoma elsewhere in your body, the MDT may decide to remove some of your lymph nodes. This helps to prevent cancer spreading to other parts of your body. 
• The lymph nodes are removed in hospital under a general anaesthetic. This is called a complete lymph node dissection (CLND).
• You may feel sore for the first few days after an operation to remove lymph nodes, but most people recover quickly. 

Lymphoedema after lymph node dissection

In a very small number of cases, swelling may occur at the site of the removed lymph nodes. For example, swelling in your arm if lymph nodes in your armpit are removed. This swelling is called lymphoedema and it can happen some time after the surgery.

Contact your doctor or specialist nurse if you notice swelling or a feeling of heaviness, tightness, soreness or stiffness in the affected area. Read more about lymphoedema.