Surgery
Surgery is the usual
treatment for melanoma. The surgeon
removes the tumor and some normal tissue around it. This procedure reduces the chance that cancer cells will be left
in the area. The width and depth of
surrounding skin that needs to be removed depends on the thickness of the
melanoma and how deeply it has invaded the skin:
The doctor may be able to completely remove a very thin
melanoma during the biopsy. Further
surgery may not be necessary.
If the melanoma was not completely removed during the
biopsy, the doctor takes out the remaining tumor. In most cases, additional surgery is performed to remove
normal-looking tissue around the tumor (called the
margin) to make sure
all melanoma cells are removed. This is often necessary, even
for thin melanomas. If the melanoma is
thick, the doctor may need to remove a larger margin of tissue.
If a large
area of tissue is removed, the surgeon may do a skin graft. For this procedure, the doctor uses skin
from another part of the body to replace the skin that was removed.
Lymph nodes
near the tumor may be removed because cancer can spread through the lymphatic
system. If the pathologist finds cancer
cells in the lymph nodes, it may mean that the disease has also spread to other
parts of the body. Two procedures are
used to remove the lymph nodes:
Sentinel
lymph node biopsy—The sentinel lymph node biopsy is done after the
biopsy of the melanoma but before the wider excision
of the tumor. A radioactive substance
is injected near the melanoma. The
surgeon follows the movement of the substance on a computer screen. The first lymph node(s) to take up the
substance is called the sentinel
lymph node(s). (The imaging
study is called lymphoscintigraphy. The procedure to identify the sentinel
node(s) is called sentinel
lymph node mapping.) The
surgeon removes the sentinel node(s) to check for cancer cells.
If a
sentinel node contains cancer cells, the surgeon removes the rest of the lymph
nodes in the area. However, if a
sentinel node does not contain cancer cells, no additional lymph nodes are
removed.
Lymph node dissection—The
surgeon removes all the lymph nodes in the area of the melanoma.
Therapy may be given after surgery to kill cancer cells that remain in
the body. This treatment is called
adjuvant therapy. The
patient may receive biological therapy.
Surgery is
generally not effective in controlling melanoma that has spread to other parts
of the body. In such cases, doctors may
use other methods of treatment, such as chemotherapy, biological therapy,
radiation therapy, or a combination of these methods.
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