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Reconstructive surgery and melanoma

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Most melanomas, especially early-stage, require surgery. A surgeon may remove the cancerous lesion and close the hole it leaves.

Some patients need reconstructive surgery to hide scars or irregularities caused by the skin cancer surgery, especially if your skin was removed from a visible part of the body or a large area was taken.

Your surgeon may use different procedures to reconstruct the area where the melanoma was removed, including:

Local flap stretches healthy adjacent tissue to cover the wound. Your doctor also may refer to this surgical procedure as adjacent tissue rearrangement. Often, the flap remains attached to a blood vessel from its original site.

Skin graft takes a thin bit of healthy skin from another area of your body and used to close the site of the cancer surgery. Your doctor is likely to take healthy skin from an area that isn’t generally visible, such as parts of the thigh or buttocks. Skin grafts don’t have their own blood supply. They receive nutrients and blood supply from the underlying wound bed.

Reconstruction may need to be done in stages, depending on the size of your wound.

Who performs reconstructive surgery and where?

A number of surgeons may perform your reconstruction:

  • Oncologist who removes the melanoma
  • Plastic surgeon who specializes in reconstruction after cancer
  • Surgeon who specializes in skin reconstruction

Reconstructive surgery may be performed at the same time as the initial cancer surgery or shortly afterward.

The timing of your reconstruction may depend on whether you need other cancer treatments, such as chemotherapy or radiation, and whether your initial surgery needs to heal.

Reconstructive surgery may be performed in the hospital, a doctor’s office, a clinic or surgical center. It depends on who is performing the surgery and your overall health.

Patients who have melanoma removed from the head or neck may require overnight stays in the hospital while undergoing skin reconstruction because of the complexity of the procedure.

How to prepare

The more you know about the reconstructive surgery and your surgeon’s plans, the more comfortable you may feel. Be sure to ask your surgeon any questions you may have, including:

  • How often have you performed this type of reconstructive skin surgery?
  • Why do you recommend this type of surgery for me?
  • How long will the procedure take?
  • What possible complications/side effects may I experience?
  • Are you doing a skin graft and, if so, which area will you be taking skin from?
  • What will it feel like?
  • How long will it take for me to heal?
  • What is the likely outcome?
  • Will I need more surgery afterward?

Most skin grafts are done under general anesthesia. This will require that you:

  • Not eat or drink anything for at least six hours before the procedure.
  • Ask your doctor whether you should take your regular medications before surgery.
  • Arrange for someone to drive you to and from your surgery.
  • Ask if you need to remove any dental bridges. (You may be given a face mask or have a tube inserted in your windpipe to help you breathe.)

If you smoke, it’s recommended that you stop at least two days before your surgery is scheduled, and don’t resume smoking for at least a week afterward. Smoking slows the healing process.

Types of skin grafts

There are different types of skin grafts, including:

Split-thickness skin graft removes the epidermis, the outermost layer of the skin, and a part of the dermis, the thick layer of skin that contains a number of structures, including oil and sweat glands, hair follicles and blood vessels. Your surgeon places it over the hole left by the excision for melanoma and stitches or staples the new skin in place. A surgical dressing is then placed over the site. Sometimes, a well-padded dressing covers and holds a skin graft in place. Split-thickness skin grafts are often used for large wounds.

Full-thickness skin graft, a more complicated procedure than a split-thickness skin graft, is performed when the surgeon has had to remove deep tissue. Healthy tissue is taken from your back, chest wall or abdominal wall. It’s best when your donor site matches your recipient site in thickness, color and texture. A full-thickness skin graft requires taking a full thickness of skin—the top layer and layers underneath, not just the top two layers—and placing it directly over the area that needs repair. Full-thickness skin grafts are used for small areas with little or no blood supply and for larger areas with good blood supply. As with a split-thickness skin graft, the surgeon secures the replacement skin with staples, stitches or surgical dressing. A dressing is used to cover the site.

Caring for your skin graft

Your doctor will place a sterile dressing over your skin graft. It’s important to keep the area clean and dry and to give it time to heal. Keep the area covered anywhere from three to seven days. The bandage will need to be changed periodically for a couple of weeks.

Don’t exert excessive force or movement. Avoid activities that are strenuous, such as running or bicycling or weight lifting, until you get your doctor’s OK. You should avoid these activities for at least two weeks.

Avoid exposing the area to the sun. The sun may cause irregular pigmentation or scars that are raised and red. Sun also increases the risk of developing another skin cancer.

Follow your doctor’s instructions for care of your donor site as well. Ask when you may apply lotion to promote healing. Don’t rub the site for at least three to four weeks.

It also helps recovery if you:

  • Get quality sleep
  • Eat a healthy diet
  • Drink plenty of liquids

If your doctor prescribed antibiotics or suggested pain relievers, take them as directed.

Call your doctor immediately if you have signs of distress, such as:

  • Trouble breathing
  • Shortness of breath
  • Chest pain
  • Bloody cough

Check with your care team if you notice:

  • Loosened stitches
  • Bleeding at either site
  • Swelling, pain, warmth or redness at either site
  • Signs of an infection, such as fever or pus from the incision

A wound-care team should monitor your recovery. It may take more than a year until the incisions fade and your skin looks more normal.

Results of reconstructive skin surgery

Split-thickness skin grafts have a success rate of 70 percent to 90 percent, according to StatPearls Publishing. A lot depends on the skill of your surgeon and the care team looking out for you after surgery.

It’s possible that your skin graft doesn’t take. If that’s the case, speak with your surgeon about repeating the surgery and trying again.

If you smoke, the chances of your graft taking are lowered.

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