Wide excision for melanoma

Although a biopsy may be used to diagnose and remove some of your melanoma, your doctor is likely to recommend a surgical procedure known as wide excision. Considered a fairly minor surgery, wide excision involves removing the entire area that’s suspected to be cancerous, along with some margins (normal, healthy tissue) to be sure all the cancer is removed.

Wide excision is also performed when your melanoma has:

• Spread to nearby lymph nodes 
• Returned after treatment
• Spread to different parts of your body

What happens during a wide excision

During a biopsy, doctors typically make a narrow incision, about 1 to 2 mm in length. Wide excision requires a larger incision so that your surgeon is sure to remove the entire tumor and the healthy tissue surrounding it.

Your surgeon determines how much tissue needs to be removed based on the answer to these questions:

• Are melanoma cells in surrounding skin and tissue?
• Has your melanoma grown into tissue below your skin?
• Where is the melanoma located?
• Is the melanoma close to a joint that could affect your movement after surgery?

How a wide excision is performed

Wide excision is likely to be performed as an outpatient day procedure, under a local anesthetic. The area is numbed so you don’t feel anything, but you’re kept awake. The small area is closed with stitches or clips.

The procedure may be done under general anesthesia if your surgeon needs to see whether your lymph nodes are involved or if the area that needs to be removed is large.

If a large area of skin is removed, you may need a skin graft to cover what was taken. During a skin graft, surgeons take healthy skin from elsewhere on the body and use it to cover the skin that was lost.

After a wide excision procedure, you’re likely to feel some tightness while your skin heals. You also may feel tenderness in the area.

If you have stitches, they may need to be removed at your doctor’s office.

Your doctor may request a follow-up appointment within four to six weeks to see how the wound is healing.

How to prepare for a wide excision

Preparation depends on whether your wide excision will be performed under local or general anesthesia.

If you’re having general anesthesia:

• Don’t eat or drink anything for at least six hours before the procedure.
• Tell your doctor about any medications you’re taking, and ask whether you should stop them beforehand. Some medications affect anesthesia.
• Plan to have someone drive you to and from the procedure, as you may not be able to operate a car or other vehicle for at least 24 hours after surgery.
• You should not drink alcohol for at least a full day after your procedure.

With local anesthesia, there’s not much you need to change or do beforehand. Getting a good night’s sleep and eating a healthy diet are always a good idea. Ask with your care team about any special instructions.

After the procedure, drink clear liquids and eat light to prevent stomach upset.

Give the area time to heal. Ask your doctor when it’s safe to resume your normal activities, including exercise.

What to expect after a wide excision

The area that was anesthetized may stay numb for several hours afterward.

After your surgery, you may need:

• Pain medicine. Talk to your doctor about what to use and whether you need a prescription for painkillers. You’re likely to feel more pain if you underwent a skin graft. The area should feel fine with time.
• Wound care. You may be given instructions on how to care for your wound and keep it clean to prevent infections. Inform your doctor if your skin doesn’t appear to be healing properly.

Possible risks of a wide excision

Even though it’s a minor procedure, wide excision is still surgery. Watch out for:

• Infection. Signs the area may have become infected include redness, a painful sore and a fluid discharge.
• Nerve pain. If you have tingling or numbness, it’s possible a nerve was injured. It should heal with time. Talk to your doctor if it’s bothersome or doesn’t heal in a few days.
• Bruising and swelling. The area where your skin was removed may turn black and blue, or swell. If the wound doesn’t heal in a short time, reach out to your care team.
• Scarring. You’re likely to develop a scar—the bigger the melanoma, the bigger the scar. The scar is likely to be red at first, but it typically fades with time. If your scar is thick and raised, it may be considered a hypertrophic scar or a keloid.
• Bleeding. Some people experience bleeding at the wound site after surgery. Call your doctor right away if you can’t get the bleeding to stop within a reasonable time.

If you have any questions about how well you’re healing, you may not want to wait until your four- to six-week follow-up appointment with your doctor. Call your care team if you notice anything you’d like to discuss.

Potential benefits and results of a wide excision

Wide excision is typically recommended as a treatment option for localized melanoma. Overall, the five-year survival rate for localized melanoma is 99 percent, according to the American Cancer Society.

Your surgeon doesn’t want to remove skin unnecessarily. However, the smaller the margins, the greater the risk of melanoma recurring. Talk to your doctor about how much area may be surgically removed and why.

After your doctors have removed all the melanoma that they see while operating and they receive the report from the pathology lab, they may recommend chemotherapy to lower any chances of melanoma returning.