Wide local excision

Surgery to remove a larger area of healthy skin from around where the melanoma was, is known as a wide local excision. How much skin is removed depends on whether any melanoma cells might have been left behind in the surrounding skin, how deep the melanoma is and the position of the melanoma on the body.

You may have the wide local excision under a local anaesthetic in the day surgery unit. The doctor will put in stitches to close up the area where they remove the skin. This can feel a little tight at first. But as it heals, the surrounding skin will stretch and the tightness should ease.

Sentinel lymph node biopsy

If your melanoma is deeper than 1mm (stage 1B to 2C), you might be offered a sentinel lymph node biopsy. This is a test to find the first lymph node or nodes that a melanoma may spread to, and then check for the presence of cancer cells. You would have a sentinel lymph node biopsy at the same time as your operation to remove the melanoma.

 

Skin grafts[i]

Sometimes your doctor needs to remove a large area of skin, you might have a skin graft to help repair it. A skin graft is a layer of skin taken from another part of the body and placed over the area where the melanoma was removed. The place where the skin is taken from is known as the donor site. The place where it is moved to is called the grafted area. The amount of skin that’s taken depends on the area to be covered. Your doctor or specialist nurse will tell you more about this.

The grafted area

The grafted area may be secured with stitches. You’ll have a dressing over it, which will be left in place while the graft heals. The skin graft will connect with the blood supply in the area. This usually takes 5–7 days. It will look red and swollen to begin with, but eventually it will heal, and the redness will fade.

The donor site

You will have a dressing on the donor site to protect it from infection. How long the site takes to heal will depend on how much skin was removed. If skin was taken from the thigh, buttock or upper arm, it may take up to two weeks to heal. If it was taken from the neck, behind the ears or the inner side of the upper arm, it may only take about five days to heal. The donor site can often feel more uncomfortable than the grafted area. You may need to take regular painkillers for a while.

After skin graft surgery

After a skin graft, it is usually possible to go home on the same day.

Try not to do too much during the first couple of weeks after your skin graft. You’ll need to allow the graft to heal properly. The grafted area will be quite fragile, so it’s important not to put pressure on it, or rub or brush against it. Some people may need to take some time off work until it’s healed. If you have children, you may need some extra help at home until you feel able to do the things you normally do.

Your stitches will be removed 5–14 days after your operation. Some people may have stitches that dissolve and don’t need to be removed. Both the grafted and donor areas will develop scars. These should gradually become less noticeable. There will also be some difference between the grafted skin and the skin surrounding it. This will lessen over time. Your hospital team can tell you more about what to expect.

Skin flaps

A skin flap is a slightly thicker layer of skin than a graft. It is taken from an area very close to where the melanoma was. The flap is cut away but left partially connected so it still has a blood supply. It’s moved over the wound and stitched in place. If you have a skin flap, you may need to stay in hospital for up to four days.

Skin flap surgery is very specialised and it is usually done by a plastic surgeon. If you need a skin flap, your doctor will be able to tell you more about it.

See other treatment options

[i] NHS. Plastic surgery: How it’s performed. Last accessed November 2018.