Melanoma Surgery

Over 95 percent of all melanoma cases are treated surgically. Skin cancer surgery may be as simple as removing a suspicious mole for biopsy, or as complex as the removal of local lymph nodes. If the cancer has not metastasized, skin cancer surgery may cure the disease completely.

Simple Excision and Biopsy

A biopsy is the only sure way to diagnose melanoma. During a biopsy a sample of tissue is cut away from the body and examined microscopically for evidence of cancer. Small tumors may be completely removed in a biopsy, a process called simple excision. Simple excision removes the tumor and a layer of normal surrounding tissue. A scar remains where the tumor is removed. If the tumor is large it will not be completely excised during biopsy: instead, only a sample of tissue is taken.

Re-Excision of the Tumor

If the biopsy results indicate cancer, re-excision removes additional tissue from the tumor area. The procedure attempts to remove all traces of the tumor. If the tumor was completely removed for the biopsy, a second layer of healthy tissue is removed in case cancerous cells have penetrated to lower layers.

The area of surrounding healthy tissue removed is determined by how deeply the melanoma has penetrated the skin. Generally, a one-millimeter deep tumor will require the removal of one centimeter of surrounding tissue. Tumors with a thickness of over one millimeter require that two centimeters be removed. To close the resulting wound, the surgeon may use a skin graft a portion of skin taken from a healthy area of the body.

Mohs Surgery

Mohs surgery is a highly specialized form of excision. The procedure is often used in areas of the body where standard excision is difficult or disfiguring, such as the eyelids, the ears and the nose. Surgeons who perform Mohs surgery require special training in the procedure.

The melanoma is removed layer by layer. Each layer is examined for signs of cancer using a microscope. The operation continues until a layer displays no signs of malignancy. This allows the surgeon to remove as much of the cancer as possible, while conserving surrounding skin tissue.

Amputation

A melanoma on a toe or finger may necessitate the amputation of that digit. Amputation was once also used to treat melanoma found on arms and legs, but medical advances now provide less dramatic alternatives to such extreme measures.

Skin Laser Surgery

Skin laser surgery can be used to remove tumors with minimal scarring. Thin melanoma growths may be removed using a carbon dioxide laser. For deeper tumors, a type of laser skin surgery called photodynamic therapy may be used.

Photodynamic therapy uses special chemicals that react to laser light. The chemicals are injected into the tumor, and then exposed to laser light. This triggers a chemical reaction that kills the tumor cells.

Sentinel Lymph Node Biopsy

If a melanoma spreads, it usually attacks nearby lymph nodes first. To determine whether the spread has begun, a sentinel lymph node biopsy (SLNB) may be performed. An SLNB is recommended for any melanoma more than one millimeter thick.

Either a dye or a mildly radioactive substance is injected into the tumor. This substance then flows through the lymph ducts and into the lymph nodes. The closest node to the tumor is labeled the sentinel node, and will be the first to absorb the dye or radioactive material. The sentinel node is then removed for biopsy. If no evidence of cancer is found in the sentinel node, it is usually assumed that the disease has not spread further into the body.

Dissection of the Lymph Nodes

Because cancer is sometimes found in the local lymph nodes, a therapeutic lymph node dissection, or TLND, may be required. In TLND, suspicious or abnormal looking lymph nodes are removed from the cancerous area.

An elective lymph node dissection removes all lymph nodes surrounding the tumor. An ELND is more invasive than a TLND, and has the potential for more side effects. Studies have not proven that an ELND improves long-term survival rates, so the treatment remains controversial.

Both therapeutic and elective lymph node dissection may result in lymphedema or fluid accumulation. The lymph nodes under the arms and in the groin region help drain fluid from the body. If this ability is compromised, fluid retention may occur in some areas of the body.

Resources

American Cancer Society. (nd). How is melanoma skin cancer treated? Retrieved May 20, 2003, fromwww.cancer.org/docroot/cri/content/cri_2_2_4x_how_is_melanoma_skin_cancer_treated_50.asp.

American Melanoma Foundation. (nd). Surgery. Retrieved May 20, 2003, fromwww.melanomafoundation.org/diagnosis/surgery.htm.National Cancer Institute. (updated 1999). Lasers in cancer treatment. Retrieved May 21, 2003, from cis.nci.nih.gov/fact/7_8.htm.

National Cancer Institute. (updated 2002). Melanoma (PDQ) treatment. Retrieved May 20, 2003, from www.cancer.gov/cancerinfo/pdq/treatment/melanoma/patient/.

National Cancer Institute. (2003). What you need to know about melanoma. Retrieved May 20, 2003, from www.cancer.gov/cancerinfo/wyntk/melanoma#13.

Oncology Channel. (updated 2003). Melanoma. Retrieved May 20, 2003, from www.oncologychannel.com/melanoma/treatment.shtml.