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Melanoma is a type of skin cancer. It often starts as a mole or dark spot on the skin. It spreads faster than many other types of cancer. And it can be fatal if not treated. During the surgery, the tumor (area that contains cancer cells) is removed. This may keep the cancer from spreading to the deeper layers of the skin and the rest of the body. If the cancer is caught early, it has a high chance of being cured.
Lymph nodes are small masses of tissue that are part of the body’s immune system. The sentinel node is the first lymph node a tumor drains into. So, it’s the first place that cancer is likely to spread. Depending on the thickness of your tumor, either the sentinel node or all the nearby lymph nodes may need to be removed. A sentinel node biopsy is a test often done during melanoma removal surgery. This helps the doctor know which lymph nodes to remove. If you will have a sentinel node biopsy, your doctor can tell you more about what to expect.
Prepare for the surgery as you’ve been told. In addition:
Tell your doctor about all medications you take. This includes herbs and other supplements. It also includes any blood thinners, such as Coumadin, Plavix, or daily aspirin. You may need to stop taking some or all of them before surgery.
Do not eat or drink during the 8 hours before your surgery, or as directed by your surgeon. This includes coffee, water, gum, and mints. (If you have been instructed to take medications, take them with a small sip of water.)
If you’re having a sentinel node biopsy, you may have an injection of harmless dye the day before surgery.
The surgery takes about 2-3 hours. You go home the same day.
Before the surgery begins:
An IV line is put into a vein in your arm or hand. This line supplies fluids and medications.
You will be given medication to keep you pain free during surgery. This may be general anesthesia, which puts you into a state like deep sleep. (A tube may be inserted into your throat to help you breathe.) Or you may have sedation, which makes you relaxed and sleepy. If you have sedation, local anesthesia will be injected to numb the area being worked on. The anesthesiologist will discuss your options with you.
During the surgery:
If you’re having a sentinel node biopsy, harmless blue dye is injected to help the doctor locate lymph nodes where cancer may have spread.
An incision is made at the tumor site. The tumor is removed along with some of the normal tissue around it. This helps ensure that any cancer cells that may have spread to nearby skin are removed.
One or more lymph nodes near the tumor may be removed. These are checked for cancer cells (a sign that cancer has spread).
The incision may be closed with stitches (sutures) or staples. In some cases, a skin graft or flap may be needed to help close the site. This can come from your own body, a donor, or manmade sources. The doctor will discuss the different types of grafts with you before the surgery.
You’ll be taken to a room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You’ll be given medications to manage pain. When it’s time for you to be released from the hospital, have an adult family member or friend ready to drive you.
Once at home, follow the instructions you’ve been given. Your doctor will tell you when you can return to your normal routine. Be sure to:
Take all medications as directed.
Care for your incision as instructed.
Avoid heavy lifting and strenuous activities as directed.
Avoid driving until your doctor says it’s okay. Don’t drive if you’re taking medications that make you sleepy or drowsy.
Follow your doctor’s guidelines for showering. Avoid swimming, bathing, using a hot tub, and other activities that cause the incision to be covered with water until your doctor says it’s okay.
Chest pain or trouble breathing (call 911 or other emergency service)
Fever of 100.4°F or higher (or as directed by your doctor)
Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Pain that cannot be controlled with medications
You will have follow-up visits so your doctor can see how well you’re healing. If needed, stitches or staples will be removed at one of these visits. You and your doctor can also discuss any further treatments you may need.
Scarring at the surgery site
Problems with the skin graft (if one was used)
Failure to remove all of the cancer, requiring further treatments
Risks of anesthesia (the anesthesiologist will discuss these with you)
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