Melanoma Excisions

Melanoma is an aggressive form of skin cancer that should be promptly treated following a diagnosis. After a biopsy, your pathology will provide specific details about the melanoma lesion that will help with staging the lesion and will guide how you are treated.

Melanoma will be surgically removed with a margin of "healthy skin" around the lesion. The amount of skin that will need to be removed depends on the depth of your melanoma, which is seen on your pathology report.

Because of the way that melanoma cells behave, we cannot evaluate the specimen during your procedure. We will send the specimen to a lab and typically hear back on whether all of the melanoma edges are clear about 1 week following your surgery.

Depending on the stage of your melanoma lesion, you may need a lymph node biopsy before your melanoma is removed or additional treatment after the melanoma is removed. Dr. Holcombe collaborates with dermatologists, general surgeons, ENT surgeons, and oncologists when more comprehensive care is needed to address an advanced melanoma.

How much skin will be removed for a melanoma?

For a melanoma in situ, we will circle the lesion (or biopsy scar, whichever is larger) and then remove an additional 0.5 cm margin around the entire lesion.

For all other melanoma lesions, we determine how much skin to remove based on the Breslow Depth, which is reported on your initial pathology report from the biopsy.

For a Breslow Depth less than 1 mm: we will remove a 1 cm margin around the entire lesion

For a Breslow Depth of 1-2 mm: we will remove a 1.5 cm margin around the entire lesion

For a Breslow Depth over 2 mm: we will remove a 2 cm margin around the entire lesion

As you can now understand, you may have a large wound to close after a melanoma is removed. It is important that we remove the entire margin of skin that is recommended, as melanoma can be aggressive and spread if left untreated.

Wound closure is Dr. Holcombe's expertise, and we will work hard to minimize your scar and close your wound in a way that promotes healing.

Will I need a lymph node biopsy?

This depends on the initial pathology report from your biopsy. For melanoma in situ lesions and melanoma lesions staged as "pT1a" on your pathology report, it is likely that you will not need a lymph node biopsy. For other more advanced melanoma lesions, it is possible that you will need a lymph node biopsy. Dr. Holcombe and Elizabeth will review your pathology report in detail and discuss treatment recommendations during your consultation.

What is melanoma in situ?

Melanoma in situ means that the melanoma cells are contained in the top layer of the skin (the epidermis). This means that the melanoma cells have not spread to deeper layers of skin, and these lesions can be surgically removed without requiring additional treatment.

Will I need additional treatment for melanoma after surgery?

This depends on the initial pathology report from your biopsy and the final pathology report after surgery. For melanoma in situ lesions and melanoma lesions staged as "pT1a" on your pathology report, it is likely that you will not need additional treatment after surgery. For other more advanced melanoma lesions, it is possible that you will need further treatment. Dr. Holcombe and Elizabeth will review your pathology report in detail and discuss whether you will need to see another specialist, like an oncologist, during your consultation.

After The Cancer is Removed

Dr. Holcombe's expertise is minimizing scars

The first goal of surgery is to remove the cancer completely, and for melanoma lesions this means that we will need to excise a specific margin of skin around the melanoma. The excision of a melanoma can create a large wound, so depending on the location and size of your wound we will discuss the best way to repair it. You will have a scar after surgery, but we will work hard to minimize the scar and repair the wound in a way that encourages healing.

There are different ways of repairing wounds, and the best option will depend on the size and location of the wound. Dr. Holcombe may use primary repair, closing the wound in a straight line, or he may need to create a skin flap to reduce tension for larger wounds. If he cannot use either of those methods, he will use a skin graft to close the wound.

Preparing For Surgery

Surgery Location

We most often remove melanoma lesions at St. Joseph Outpatient Surgery Center so we have all of the resources we need to safely and properly remove your cancer and close your wound. If you have high risk medical conditions, St. Joseph Hospital is another location where we operate. We will let you know the location of your surgery on the day of your consultation.

Checking In

If you require surgery outside of our office, please be prepared to check into the surgery location at least one hour before your scheduled surgery time. While most of the melanoma surgeries are done under local anesthesia (meaning, you'll be awake), you will change into a hospital gown and have the procedure in an operating room. This allows us to have all of the resources necessary to remove your cancer and close your wound in the best possible way.

Eating and Drinking

If your surgery is done while you are awake, you can eat and drink normally on the day of your surgery.

If you choose to have your surgery under general anesthesia, you will need to be fasting for at least 8 hours prior to the surgery. You will receive specific instructions prior to the surgery.

Medications

Most medications can be continued normally prior to skin cancer surgery. Please make sure that we have an updated list of your medications during your consultation so that we can give instructions for any medications that may need to be stopped.

After Surgery

We will give you specific post-operative instructions following your surgery, and you can also review our post-op instructions by following the link below.

Some things to expect:

We will ask you to avoid exercise for at least one week following surgery to allow for optimal blood flow and minimal swelling to the wound. We do not want you doing any activities that could stress the wound as it is in the early stages of healing.
You will need to do some wound care following surgery, and we will give you instructions to guide you.
We will see you for follow up at 1-2 weeks post-op to check your wounds and remove any sutures. A specific date will be given to you on the day of surgery.
If you need surgery on the lower extremities: please be prepared that you will need to elevate your leg for 1-2 weeks following surgery. This is most important for skin graft repairs, where you will need to arrange for support the week after surgery as you will be resting and elevating your leg.

Post-Operative Instructions

Melanoma