Background Information:

What are the other Names for the Procedure?

• Melanoma Surgery
• Removal of Melanoma
• Surgical Excision of Melanoma

What is Melanoma Removal surgical procedure?

• Melanoma is a form of skin cancer where the cells producing melanin start forming a tumor, which appears like a mole on the skin surface
• Irregularities in the shape of the mole, increasing size of the mole, and appearance of a large number of moles should be tested for melanoma
• Melanoma Removal is a process that involves the surgical removal of the entire melanoma
• Malignant melanoma (spread of the melanoma cancer cells throughout the body) is the most dangerous form of skin cancer

What part of the Body does the Procedure involve?

A Melanoma Removal procedure involves the removal of skin tissue that contains the melanoma along with the surrounding (1-2 cm of) normal tissue, depending on the depth of the melanoma

Why is the Melanoma Removal surgical procedure Performed?

Melanoma Removal procedure is performed as a treatment for melanoma skin cancer.

What are some Alternative Choices for the Procedure?

• Surgery to remove melanoma is the primary treatment for any stage of melanoma
• Depending on the stage of the cancer, additional treatments might be necessary such as adjuvant chemotherapy treatments and radiation treatments
• Newer treatments modality such as interferon therapy is an alternative choice considered by your healthcare provider, depending on the clinical situation

What are the Recent Advances in the Procedure?

The methodology of surgery for Melanoma Removal remains more or less, the same. However, certain advances have been achieved in the field of reconstructive surgery, where skin grafts are required to enable better and quicker results.

What is the Cost of performing the Melanoma Removal surgical procedure?

The cost of Melanoma Removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently.

What are some Helpful Resources?

http://www.cancercenter.com/melanoma/surgical-oncology.cfm

http://www.melanoma.org.au/about-melanoma

http://www.cancer.net/patient/Cancer+Types/Melanoma?sectionTitle=Treatment

http://www.med.nyu.edu/content?ChunkIID=14842

Prior to Melanoma Removal surgical procedure:

How is the Melanoma Removal surgical procedure Performed?

• A diagnosis of melanoma is confirmed by carrying out a biopsy of the skin lesion
• A local excision is made that includes the skin and tissue around the melanoma. The extent of the excision will depend upon the stage of cancer, the size and depth of the melanoma
• In case of a thin melanoma, a simple excision is made to remove the tumor and a small margin of non-cancerous cells (at least 1cm) is removed as well. The surrounding margin of non-cancerous cells is removed to prevent the recurrence of a melanoma
• In case of a thick melanoma, a wide excision is made and a much larger margin of non-cancerous cells are removed (at least 2cm)
• For melanoma more than 1mm deep, sentinel lymph node biopsy is carried out (the lymph node close to the excision is removed) to determine the spread of melanoma to the nearby lymph nodes
• The excision is then either stitched or a skin graft is used for healing the wound, depending on the site and extension of the excision. The stitches can be removed within 7-14 days

Where is the Procedure Performed?

Melanoma Removal procedure is usually performed in an out-patient surgery center facility, or at a hospital’s surgery facility, depending on the need for hospitalization.

Who Performs the Procedure?

A general surgeon, an oncology surgeon, a dermatologist, or a plastic surgeon and a reconstructive surgeon may carry out the surgery.

How long will the Procedure take?

The length of the surgery depends on the extent of the melanoma and the type of surgery planned.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the patient’s medical history to gain a comprehensive knowledge of the medications that are being taken currently
• Some of the medication may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
• Sometimes blood test might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevent them from undergoing the procedure
• A physician will request your consent for Melanoma Removal procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Melanoma Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Melanoma Removal surgical procedure?

Depending on the stage of the melanoma, the physician will require the following examinations:

• Routine blood and urine examination
• Imaging studies to determine if the melanoma has spread to other areas

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Melanoma Removal procedure?
• Why is this procedure necessary?
• What does the procedure involve?
• How will this procedure help?
• Will I need adjunct treatments after the surgery?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Melanoma Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered local anesthesia, either with or without sedation. However, in some cases, general anesthesia may be administered depending on the site and extent of the melanoma.

How much Blood will you lose, during the Procedure?

In a majority of the cases, the amount of blood lost would not merit the requirement of a blood transfusion. However, when surgical procedures involve areas near large blood vessels, blood transfusion may be required.

What are the possible Risks and Complications during the Melanoma Removal surgical procedure?

The complications that may arise during the surgery are:

• Excessive bleeding
• Infection
• Injury to the neighboring structures
• Pain
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Melanoma Removal surgical procedure?

At the healthcare facility, the stitches or sutures have to be removed, as directed by the surgeon. Apart from that, generally there is no requirement for any post-procedure care at the facility, unless any complications arise.

After the Melanoma Removal surgical procedure:

What are the possible Risks and Complications after the Melanoma Removal surgical procedure?

The complications that may arise after the surgery are:

• Excessive bleeding
• Infection of the surgical wound
• Nerve damage
• Recurrence of cancer due to incomplete removal of cells
• Graft rejection (if skin graft is used for healing)

What is the Prognosis after the Surgery?

It depends upon the staging of melanoma. Generally, if it is detected early, prognosis is good.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Oral temperature of 101 degrees Fahrenheit, or greater
• Persistent, severe, or increasing pain
• Bleeding from the incision, which is difficult to control with a light pressure
• Persistent nausea or vomiting
• Fluid or drainage from the incision area
• Redness around the incision area
• Incision area feels hot/warm to touch
• Foul odor from the incision area
• Swelling of the entire surgical area
• A new lump or discoloration on the skin, or any noticeable change (such as color, bleeding, itching, growth) in an already existing mole, either at the surgical site or in a new location

What Post-Operative Care is needed at Home after the Melanoma Removal surgical procedure?

At home, the following post-operative care is recommended, after a Melanoma Removal surgical procedure:

• The dressing may be removed 48 hours after the surgery (If no skin graft is used), as advised by the surgeon
• The surgical area should be kept clean and dry
• Any pain killers or antibiotics should be taken only as prescribed by the physician
• If a skin graft has been used, follow specific instructions for bathing and dressing the wound, as suggested by the surgeon

How long does it normally take to fully recover, from the Procedure?

• The recovery period depends on the site, type, and extent of the surgery; and also on the method used to heal the surgical wound
• The wound may take longer to heal if skin grafts are used

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Melanoma Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility
• An oncologist
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• A radiologist (if radiological tests were performed during the procedure)

The patient is advised to inquire and confirm the type of billing, before Melanoma Removal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA