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Treatment for early melanoma
Melanoma that is found early (stages 0–II or localised melanoma) can generally be treated successfully with surgery. If the melanoma has spread to nearby lymph nodes or tissues (stage III or regional melanoma), treatment may also include removing lymph nodes and additional (adjuvant) treatments.
Surgery to remove the mole is the main treatment for early melanoma, and it can also be the only treatment you need.
Wide local excision
Even though the excision biopsy to diagnose melanoma often removes the melanoma, a doctor or surgeon may also do a procedure called wide local excision. This means removing more normal-looking skin from around the melanoma (wider margin).
Removing more tissue around the melanoma reduces the risk of it coming back (recurring) at that site. In the latest melanoma guidelines, it is recommended that the margin is usually between 5 mm and 1 cm, depending on the type, thickness and site of the melanoma. For thicker tumours, a wider margin of up to 2 cm may be advised.
A pathologist will check the tissue around the melanoma for cancer cells. If the sample doesn’t contain any cancer cells, it is called a clear margin. If the margins aren’t clear, you may need further surgery.
A wide local excision is often performed as a day procedure using a local anaesthetic. This means you can go home soon after the surgery, provided there are no complications. People with a melanoma thicker than 1 mm will usually be offered a sentinel lymph node biopsy at the same time.
Repairing the wound
Most people will be able to have the wound closed with stitches. You will have a scar but this will become less noticeable with time.
If a large area of skin is removed, the wound may be too big to close with stitches. In this case, the surgeon may repair it using skin from another part of your body. This can be done in two ways:
Skin flap – nearby skin and fatty tissue are lifted and moved over the wound from the edges and stitched.
Skin graft – a layer of skin is taken from another part of your body (usually the thigh or neck) and placed over the area where the melanoma was removed. The skin grows back quickly over a few weeks.
The decision about whether to do a skin flap or graft will depend on many factors, such as where the melanoma is, how much tissue has been removed and your general health. In either case, the wound will be covered with a dressing. After several days, it will be checked to see if the wound is healing properly. If you had a skin graft, you will also have dressings on any area that had skin removed for the graft.
If your doctor’s examination, ultrasound or lymph node biopsy shows that the melanoma has spread to your lymph nodes (regional melanoma or stage III), you will have scans regularly and, in some cases, may be offered immunotherapy or targeted therapy (systemic treatment). If melanoma has spread to lymph nodes and caused a lump, the lymph nodes will be removed in an operation called a lymph node dissection or lymphadenectomy. This is performed under a general anaesthetic and requires a longer stay in hospital. Usually only the lymph nodes near the melanoma are removed.
Side effects of lymph node dissection
Having your lymph nodes removed can cause side effects, such as:
Wound pain – Most people will have some pain after the operation, which usually improves as the wound heals. For some people, the pain may be ongoing, especially if lymph nodes were removed from the neck. Talk to your medical team about how to manage your pain.
Neck/shoulder/hip stiffness and pain – These are the most common problems if lymph nodes in your neck, armpit or groin were removed. You may find that you cannot move the affected area as freely as you could before the surgery. It may help to do gentle exercises or see a physiotherapist.
Seroma/lymphocele – This is a collection of fluid in the area where the lymph glands have been removed. It is a common side effect of lymph node surgery. Sometimes this fluid is drained by having a needle inserted into the fluid-filled cavity after surgery.
If lymph nodes have been surgically removed, your neck, arm or leg may swell. This is called lymphoedema. It happens when lymph fluid builds up in the affected part of the body because the lymphatic system is not working as it should.
The chance of developing lymphoedema following melanoma treatment depends on the extent of the surgery and whether you’ve had radiation therapy that has damaged the lymph nodes. It can develop a few weeks, or even several years, after treatment. Although lymphoedema may be permanent, it can usually be managed, especially if treated at the earliest sign of swelling or heaviness.
How to prevent and/or manage lymphoedema
- Keep the skin healthy and unbroken to reduce the risk of infection.
- Wear a professionally fitted compression garment if recommended by your doctor or lymphoedema practitioner.
- Always wear gloves for gardening, outdoor work and housework.
- Moisturise your skin daily to prevent dry, irritated skin.
- Protect your skin from the sun
- Don’t pick or bite your nails, or cut your cuticles.
- Try to avoid scratches from pets, insect bites, thorns, or pricking your fingers.
- Do regular exercise to help the lymph fluid flow, such as swimming, bike riding or yoga.
- Massage the affected area to help move lymph fluid.
- Avoid having blood taken or blood pressure done on the arm on the affected side.
- Visit lymphoedema.org.au to find a lymphoedema practitioner or ask your doctor for a referral.
- If your skin feels swollen or hot, see your doctor as soon as possible as these may be signs of infection.
If there’s a risk that the melanoma could come back (recur) after surgery, other treatments are sometimes used to reduce that risk. These are known as adjuvant (or additional) treatment. They may be used alone or together.
Some treatments enter the bloodstream and travel throughout the body. This is known as systemic treatment, and includes:
- immunotherapy – drugs that help the body’s immune system to recognise and fight some types of cancer cells
- targeted therapy – drugs that attack specific features within cancer cells known as molecular targets to stop the cancer growing and spreading.
In some cases, people may be offered radiation therapy (also known as radiotherapy). This is the use of targeted radiation to damage or kill cancer cells.