Melanoma & Skin Cancer Surgery

Surgery is the most common treatment for skin cancers. For early cancers – a simple excision may be all that is required.

Skin Biopsy/wide excision

For lesions that are suspicious of being a skin cancer, your GP may already have performed a biopsy to confirm the diagnosis. This is usually performed in the rooms under local anaesthetic.  

For some small skin cancers, and even some melanomas – a simple excision is all that is required. The tumor is removed with a rim of normal tissue around it and the wound is stitched closed. The excised tumour is sent to a pathologist. The pathologist will confirm the type of tumour, the depth, its risk of spreading and whether it has been completely removed with a safe margin of normal tissue.   

With some tumours, like melanoma, even though the initial biopsy may have excised all the cancerous cells, a wider excision may be recommended to further reduce the risk of the skin cancer returning. This usually refers to removing a 1-2cm margin around the site of the original skin cancer. This margin may vary depending on the depth and features of the original tumour, as well as its location on the body. Most wide excisions can still be closed with stitches, for some a skin graft or local flap may be required.

Depending on the size and location of the cancer, it may be possible to perform this in rooms, otherwise the procedure can be performed as day surgery, under a light general anaesthetic.

Sentinel node biopsy

With melanoma, you may require a sentinel node biopsy at the time of your wide excision to determine if the melanoma has spread to the lymph nodes. The sentinel lymph node is the first lymph node that the cancer cells are likely to drain into. If there are no cells in the sentinel lymph node(s), it is unlikely that the cancer has spread elsewhere.

There are two main components to a sentinel node biopsy. The first is lymph node mapping. This is done in a nuclear medicine or radiology practice, and a weak radioactive tracer/dye will be injected into the site of the melanoma. This will then be tracked – to identify which is the first draining lymph node(s). This needs to be done on either the morning of, or the day before your surgery, such that Dr Saks can use the residual tracer to help detect the correct lymph node. The second part of the procedure is the operation itself which occurs under general anaesthetic. Following injection of a blue dye into the skin around the melanoma, a cut is made over the site of the lymph node and using the tracer and blue dye the required lymph node(s) is identified and removed. This is then sent to a pathologist to determine whether any cancer cells have spread to the lymph node or not.  

Lymph node dissection

In a small number of patients, the melanoma cells have already spread to the lymph nodes, by the time you see Dr Saks. This may be detected either as a lump or mass you or your doctor has examined or diagnosed on imaging scans such as ultrasound or CT. If this has occurred, you are likely to need a lymph node dissection, where all of the lymph nodes in the affected area are removed at surgery. This may be in conjunction with other treatments such as immunotherapy and radiotherapy. Dr Saks will discuss your case with other specialists in this instance, to help determine the best treatment plan with you.