Surgical excision of melanoma is the main treatment for early-stage skin cancer. .
In stage 0 and stage I melanoma, removal of the primary tumor may be the only procedure necessary for complete recovery.
The main types of operations performed for melanoma:
- wide excision (excision);
- micrographic removal (Mohs operation).
Wide excision
Wide excision (excision) involves the removal of the formation along with some healthy tissue around the edges. The tumor is excised with a scalpel under local anesthesia, making an indent of 0.5-2 cm. The size of the surgical margin depends on the thickness (germination) of the melanoma deep into the skin.
After removal of the formation, a suture is applied.
Formation thickness | Surgical edge |
non-invasive melanoma | 0.5 cm |
less than 1 mm | 1 cm |
from 2 to 4 mm | 2 cm |
more than 4 mm | 2 cm |
A pathologist examines the removed tissue for tumor involvement. If malignant cells are found in the border tissue, irradiation is performed to destroy the remaining formation. A biopsy of the sentinel nodes is also mandatory.
If malignant cells in the sentinel lymph node were found, lymph node dissection ( lymphadenectomy ) is performed - removal of the affected lymph nodes.
Mohs operation
The Mohs operation is the removal of the formation in stages, in layers. Each layer removed during the operation is examined under a microscope to detect cancer cells. The next layer is removed as long as there are tumor cells in it. This approach is gentle and allows you to remove the tumor, preserving healthy skin as much as possible.
Mohs surgery can be used for lesions of the
face , where a wide excision can leave an unwanted cosmetic defect.
Many doctors recommend Mohs surgery only for non-
melanoma skin cancers.
With damage to the limbs and deep germination of the tumor, amputation can be performed. In an effort to preserve as much tissue as possible, doctors also offer radiation and local chemotherapy (isolated limb perfusion) as alternatives.
Removal of melanoma at different stages
At stages 0 and I, the main method of treatment is a wide excision.
At stage II, the tumor is also excised, however, a biopsy of the sentinel lymph node is mandatory, and if it is damaged, lymphadenectomy is performed.
At stage III melanoma, a wide excision is performed, removal of the lymph nodes in which malignant cells were found, and drug therapy.
At the IV (last) stage, the removal of the primary tumor takes place whenever possible. For the treatment of metastases, drug therapy and / or radiation are mandatory.
Postoperative care
To accelerate the healing of a postoperative wound, it is necessary to strictly follow the recommendations of a specialist:
- keep the excision site dry, protecting with a sterile bandage;
- apply an antibiotic ointment to the bandage as prescribed by the doctor;
- avoid intense physical activity;
- if you experience any unpleasant symptoms, consult a doctor.
Side effects and complications of surgery
- infection;
- bleeding;
- cosmetic defect (scarring and scar);
- lymphedema (when removing lymph nodes).
Lymphedema is swelling and swelling of the extremities caused by stagnation of lymph during surgical removal of lymph nodes.
The symptoms of lymphedema are:
- swelling of the arm or leg from the side of the removed lymph node;
- feeling of heaviness in the hands;
- decreased limb flexibility.
Lymphedema can develop immediately after lymph node dissection, and after a long time. Carefully monitor the condition of the body and inform the doctor about any changes!