Surgery for Melanoma

Minimally Invasive Approach

At Scott & White, we use minimally invasive surgical techniques whenever possible. If your melanoma has spread to other organs in your body, your physician will assess whether you are a candidate for minimally invasive surgery.

Benefits of minimally invasive surgery include:

  • Better cosmetic result
  • Quicker recovery times, allowing you to:
    • Return to your daily routine sooner
    • Begin future treatment sooner
  • Shorter hospital stay
  • Less pain
  • Less blood loss
  • Lower risk of infection
  • Fewer complications

Not all patients are candidates for a minimally invasive approach. Factors affecting the decision to use minimally invasive techniques include:

  • Tumor size, stage or location
  • Patient obesity and health
  • Prior surgeries

Surgery is the primary treatment for all stages of melanoma.

Surgery will cure most early-stage melanomas. In the event your tumor spreads (metastasizes) to other parts of your body, you may require other treatments.

At Scott & White, treatment goals for melanoma generally are centered on skin-preserving treatments. Our philosophy is to remove as much cancer as reasonable while preserving as much of your cosmetic appearance as possible.

Surgical Procedures

The type of surgical treatment of melanoma you will receive depends on the tumor thickness. Tumors less than 1 millimeter thick can be treated as an outpatient in the Scott & White Skin Cancer Clinic with less invasive treatments with a very high cure rate.

Melanomas thicker than 1 millimeter may require surgery and further treatments. Your physician will discuss your treatment options with you.

If your melanoma is caught early, excision or Mohs micrographic surgery may be sufficient in removing 100 percent of your cancer.

Excision

In this surgical procedure, your dermatologic surgeon will remove your tumor and a small area of healthy skin and tissue around your tumor.

In most cases, your surgeon will remove a 1 to 2 cm margin of healthy tissue around your tumor. You may require a skin graft or transfer of muscle to cover the area where the melanoma was removed.

Electric Desiccation Curettage

In this surgical procedure, your dermatologist will remove your lesion and a small margin around it with a sharp spoon-like instrument (curette). Then, using a thin needle-like instrument, your dermatologist will then apply a high-frequency electric current to the lesion base, thereby cauterizing the tissue.

This procedure is used in some cases for small lesions in non-cosmetically important areas.

Mohs Micrographic Surgery

In some cases, your dermatologist may recommend Mohs micrographic surgery for your melanoma skin cancer.

In this procedure, your Mohs surgeon will cut away skin and immediately check it under a microscope for cancerous cells. The process is repeated until the skin sample is free of cancer.

Mohs surgery removes all the roots of skin cancer with the highest cure rates of any form of treatment. Mohs surgery makes the smallest possible surgical wound.

Mohs surgery is used only for certain skin cancers:

  • Very aggressive cancers
  • Those that have grown back after previous treatment
  • Cancers at risk of returning
  • Those located where preserving normal skin is important

Sentinel Lymph Node Mapping

To determine whether your melanoma has spread, in this procedure, your surgeon will check for melanoma cells in the lymph node basin that drains your tumor. Prior to your operation, your surgeon will inject a blue dye and a radioactive material into your tumor. During your operation, your surgeon, using a sensor probe, will locate the lymph node containing the blue dye and radioactive material and remove this sentinel (first) node. This node will be examined by a pathologist for the presence of cancerous cells. If melanoma is present, your surgeon will remove all of your lymph nodes in that area.

Lymph Node Removal

If your dermatologic surgeon suspects your melanoma has spread to nearby lymph nodes, or if pathology confirms that melanoma is present in the sentinel lymph node, your surgeon will remove your nearby lymph nodes, reducing the chance of recurrence of your melanoma.

Surgical Removal of Distant Tumors

In the event your melanoma spreads to other organs in your body, your surgical oncologist may recommend the surgical removal of your tumor and parts of other organs as well. In most cases, when melanoma spreads, it spreads to a single site first, such as your lung or brain.

Note

Your physician will discuss which option is best for you. As with all operations, there are some risks. Your surgeon will discuss those risks with you.

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