Can you drive after melanoma surgery?

Skin lesion removal-aftercare

Shave excision — skin aftercare; Excision of skin lesions — benign aftercare; Skin lesion removal — benign aftercare; Cryosurgery — skin aftercare; BCC — removal aftercare; Basal cell cancer — removal aftercare; Actinic keratosis — removal aftercare; Wart -removal aftercare; Squamous cell-removal aftercare; Mole — removal aftercare; Nevus — removal aftercare; Nevi — removal aftercare; Scissor excision aftercare; Skin tag removal aftercare; Mole removal aftercare; Skin cancer removal aftercare; Birthmark removal aftercare; Molluscum contagiosum — removal aftercare; Electrodesiccation — skin lesion removal aftercare

How to Care for Stitches

Stitches are special threads that are sewn through the skin at an injury site to bring the edges of a wound together. Care for your stitches and wound as follows:

Keep the area covered for the first 24 to 48 hours after stitches have been placed.
After 24 to 48 hours, gently wash the site with cool water and soap. Pat dry the site with a clean paper towel.
Your health care provider may recommend the application of petroleum jelly or an antibiotic ointment on the wound.
If there was a bandage over the stitches, replace it with a new clean bandage.
Keep the site clean and dry by washing it 1 to 2 times daily.
Your provider should tell you when to come back to get the stitches removed. If not, contact your provider.

How to Care for an Open Wound

If your provider does not close your wound again with sutures, you need to care for it at home. The wound will heal from the bottom up to the top.

You may be asked to keep a dressing over the wound, or your provider may suggest leaving the wound open to air.

Keep the site clean and dry by washing it 1 to 2 times a day. You will want to prevent a crust from forming or being pulled off. To do this:

Your provider may suggest using petroleum jelly or an antibiotic ointment on the wound.
If there is a dressing and it sticks to the wound, wet it and try again, unless your provider instructed you to pull it off dry.

Do not use skin cleansers, alcohol, peroxide, iodine, or soap with antibacterial chemicals. These can damage the wound tissue and slow healing.

After Cryotherapy

The treated area may look red afterwards. A blister will often form within a few hours. It may appear clear or have a red or purple color.

You may have a little pain for up to 3 days.

Most of the time, no special care is needed during healing. The area should be washed gently once or twice a day and kept clean. A bandage or dressing should only be needed if the area rubs against clothes or may be easily injured.

A scab forms and will usually peel away on its own within 1 to 3 weeks, depending on the area treated. Do not pick the scab off.

Important Tips

The following tips may help:

Prevent the wound from re-opening by keeping strenuous activity to a minimum.
Make sure your hands are clean when you care for the wound.
If the wound is on your scalp, it is OK to shampoo and wash. Be gentle and avoid a lot of exposure to water.
Take proper care of your wound to prevent further scarring.
You can take pain medicine, such as acetaminophen, as directed for pain at the wound site. Ask your provider about other pain medicines (such as aspirin or ibuprofen) to make sure they will not cause bleeding.
Follow-up with your provider to make sure the wound is healing properly.

When to Call the Doctor

Call your provider right away if:

There is any redness, pain, or yellow pus around the injury. This could mean there is an infection.
There is bleeding at the injury site that will not stop after 10 minutes of direct pressure.
You have a fever greater than 100°F (37.8°C).
There is pain at the site that will not go away, even after taking pain medicine.
The wound has split open.
Your stitches or staples have come out too soon.

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After full healing has taken place, call your provider if the skin lesion does not appear to be gone.

References

Addison P. Plastic surgery including common skin and subcutaneous lesions. In: Garden OJ, Parks RW, eds. Principles and Practice of Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 18.

Dinulos JGH. Dermatologic surgical procedures. In: Dinulos JGH, ed. Habif’s Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 27.

Newell KA. Wound closure. In: Richard Dehn R, Asprey D, eds. Essential Clinical Procedures. 4th ed. Philadelphia, PA: Elsevier; 2021:chap 32.

Version Info

Last reviewed on: 5/31/2022

Reviewed by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Surgery for melanoma

Surgery is the main treatment for melanoma. You might have surgery to remove:

an early stage melanoma
the lymph nodes close to the melanoma if the cancer has spread there
melanoma that has come back in the same place following an operation
melanoma that has spread to other parts of the body

Surgery to remove more tissue (wide local excision)

Doctors diagnose melanoma by removing the abnormal mole or area of skin. They send it to the laboratory to check if it’s a melanoma and how thick it is.

It’s likely you’ll have a second operation to remove more tissue if you’re diagnosed with melanoma. This is called a wide local excision. Your doctor removes a larger area of healthy skin and tissue from around where the melanoma was. This helps to reduce the risk of the melanoma coming back.

How much tissue you have removed depends on:

whether melanoma cells are in the surrounding skin and tissue
how deep the melanoma has grown into the tissue beneath the skin
the position of the melanoma on your body
whether the surgery will affect your movement afterwards (for example, if the melanoma is close to a joint)

The National Institute for Health and Care Excellence (NICE) recommend that for :

stage 0 melanoma (melanoma in situ), your doctor removes at least 0.5cm of tissue around the melanoma
stage 1 melanoma, the surgeon removes at least 1 cm of tissue around the melanoma
stage 2 melanoma, the surgeon removes at least 2 cm of tissue around the melanoma

What happens

Generally, this is a small operation. You usually have it as an outpatient, under local anaesthetic. This means you’re awake for the operation but have an injection to numb the area.

The doctor will put in stitches or clips to close up the area where they remove the tissue. This can feel a little tight at first. But as it heals, the surrounding skin stretches and the tightness should ease.

You might need to be asleep for the operation (have a general anaesthetic) if the doctor needs to:

check your lymph nodes (sentinel node biopsy)
remove a large area of skin or repair it with a skin graft or skin flap

Find out about having a sentinel lymph node biopsy

Skin graft and skin flap

You might have a skin graft or flap to cover the wound if your doctor needs to remove a large area of skin.

Most people who have a wide local excision don’t need a skin graft or flap. The area can heal up well without one.

Skin graft

For a skin graft, your surgeon removes a thin sheet of skin from somewhere else on your body (the donor site). They then place it over the area where the melanoma was.

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The donor skin is usually taken from somewhere where it won’t be too obvious, such as your inner thigh or behind your ear. At first the area looks like a graze. It may feel quite sensitive or painful at first. The skin grows back quite quickly, usually over a couple of weeks.

The skin graft is very delicate while it heals. It’s vital that the graft is not damaged during this time. Try not to knock it. You might have antibiotics to help prevent an infection.

Skin flap

For a skin flap, your surgeon takes some skin with its own blood supply from an area next to where the melanoma was. There are different types of skin flaps and sometimes you may need more than one operation for the type of skin flap you’re having. Your surgeon explains what you need before you have the operation.

Skin flaps are often used for the face. Your surgeon will do their best to make sure the cuts (incisions) they make during the operation fit in with the natural lines of your face so that any scars are hidden.

Surgery to remove lymph nodes

If you have swollen lymph nodes near to the melanoma that your doctor can feel, you usually have an ultrasound scan and biopsy. Your doctor takes a sample from the nodes using a fine needle ( fine needle aspiration ) or a core needle biops y to check for cancer cells.

You might have surgery to remove the lymph nodes in the area if cancer has spread there. This is a lymph node dissection.

Go to information about surgery to remove lymph nodes

After your surgery

You can usually go home the same day as your surgery.

You have a dressing over your wound to protect it. This is usually kept in place for a day or more. If you have had a lymph node dissection you may have a drain that you can take home.

Your surgeon may use dissolvable stitches to close the wound, which they don’t need to remove. For other types like stitches or clips you need to go back to the hospital 5 to 14 days after your surgery so the nurse can take them out. They will also check how your wound is healing.

If you’ve had a local anaesthetic to part of your face

Having a local anaesthetic to the middle or lower part of your face means that you won’t be able to feel anything until it has worn off. So you should avoid hot food and drink until the sensation has returned, as there is a risk of burns.

If you’ve had a general anaesthetic

You first go to the recovery area after having an operation under general anaesthetic. A nurse regularly checks you. They offer you a snack and drink when you are more awake. You might be in the recovery area for a couple of hours.

When the anaesthetic has worn off and you feel well you can go home. This might be on the evening of the operation or the next day.

After a general anaesthetic you’ll need a friend or relative to take you home and stay with you overnight. Also, for 24 hours after the general anaesthetic you shouldn’t:

drive
drink alcohol
operate heavy machinery
sign any legally binding documents

Problems after a wide local excision

As with any operation, there is a risk of complications. Before offering you surgery, your doctor makes sure the benefits of having the operation outweighs any possible risks.

Your doctor or nurse will let you know what to look out for after your surgery and who to contact if you have any problems. These might include:

Pain

You might have some mild pain at the wound site. Or at the site you had the skin graft. Simple pain relief like paracetamol can help. If it’s not helping contact your doctor to get stronger pain relief.

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Infection

Some people get an infection after their operation. Contact your GP or the department where you had the surgery if your wound:

looks red
is very sore and getting more painful
has fluid (discharge) leaking from it

You may need treatment such as antibiotics.

Numbness

You may have some numbness, tingling and pain in the area. This is due to nerve injury and may get better with time. Talk to your doctor or specialist nurse if this is troubling you.

Bruising and swelling

You might have some bruising and swelling around the area of your operation. This goes down over time as the wound heals. Contact your doctor or nurse if the swelling gets worse.

Bleeding

You might have a small amount of bleeding after surgery. If your wound continues to bleed or gets worse contact the department where you had surgery or go to your local Accident and Emergency (A&E) department.

Avoid strenuous exercise or activity after surgery to reduce the risk of bleeding. Your doctor or nurse will tell you how long for.

Scarring

You’ll have a scar. The size and shape of your scar will depend on how big the melanoma was and if you needed a skin graft or flap.

Scars are quite noticeable and red to start with, but they get paler and less noticeable over time. Some scars can be quite thick and raised (hypertrophic or keloid). Talk to your doctor about any worries you might have about your scar.

Follow up

You see your doctor about 4 to 6 weeks after surgery. Your doctor:

gives you the results of the surgery
examines you
asks how you are and if you’ve had any problems
checks how your wound or wounds are healing
plans further treatment and follow up

This is also your opportunity to ask any questions. Write down any questions you have before your appointment to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says and provide support.

Between appointments, you can also contact your specialist nurse, they are also known as key workers in some hospitals. So don’t worry if you do forget to ask something.

How often you have follow up appointments depends on the results of your surgery. Ask your doctor how often you need to have check ups and what they will involve.

Surgery to remove melanoma that has spread

You might have surgery to remove melanoma that has spread to other areas of the skin or body, such as the lungs, skin and bowel. Cancer that has spread to another area of the body is called secondaries or metastases. The operation you have depends on which part of the body the melanoma has spread to.

For example, you might have surgery to remove a secondary melanoma in the skin. Or it might be possible for some people to have an operation to remove a secondary melanoma in their lung or bowel. This operation is more likely if there are no other signs of melanoma elsewhere in the body. And you need to be reasonably fit and well to have this operation.

It is not usually possible to cure the melanoma. But some people can stay well for months or sometimes years after having several different treatments such as surgery to remove metastases, targeted cancer drugs or immunotherapies.

Find out more about treatment for cancer that has spread

References

Melanoma assessment and management
National Institute for Health and Care Excellence (NICE), July 2015
BMJ Best Practice Melanoma
BMJ Publishing Group, June 2018
Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
R Drummer and others
Annals of Oncology, 2015. Volume 26, Supplement 5, Pages v126 — v132
Current procedures: Surgery. Chapter 28. Operative Management of Melanoma
A A Ghaferi and M S Sabel
The McGraw-Hill Companies, 2010
Melanoma. A Modern Multidisciplinary Approach
A I Riker
Springer, 2018.
The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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Melanoma Removal

Melanoma is a cancer of melanocytes, which are cells that produce melanin, the pigment that is primarily responsible for giving skin its color. Melanoma can be found anywhere on the body where melanocytes are present.

Indications:

Melanoma removal surgery is performed to make sure all of the cancer has been removed after a skin biopsy tests positive for melanoma. In the event melanoma has spread (metastasized) from the skin to other organs, melanoma removal might also be indicated to control the cancer and determine the extent to which it has spread. The procedure to remove melanoma from the skin is often referred to as a wide-excision.

Pre-Operative Evaluation:

Before you are scheduled for any melanoma removal surgery, you should expect a detailed consultation with the surgeon discussing all of your surgical options and how surgery will be coordinated with other treatments such as radiation and immunotherapy if recommended. There are many factors that help to determine the timing and sequence of your treatment plan and your surgeon will work to explain these factors to you in developing your individualized surgical plan.
Routine blood work, chest x-ray and heart studies such as an EKG can be ordered prior to surgery based on your age and the presence of any existing medical conditions.

You may be instructed to stop taking some medications before surgery. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. For more information related to preparation for surgery click here.

Procedure:

Wide-Excision of Melanoma is usually performed under a general anesthesia, so you will not feel anything. The procedure itself is performed through an incision made over the location of the melanoma after local anesthesia (numbing medicine) has been injected in the area. The tumor along with some of the surrounding healthy tissue will be removed. The amount of healthy tissue, or margins, removed in addition to the tumor will depend upon the thickness and location of the tumor. Once tissue removal is complete, the incision will be meticulously closed with suture the majority of the time. The suture will be removed at the post op visit if required after surgery. Larger excisions may require skin grafting or creation of skin flaps to close the exposed area.

Additional procedures may be performed at the time of the wide-excision. Please keep in mind that each patient situation is different, which is why our highly trained and experienced surgeons are here to guide you through these complex decisions.

Information about additional procedures is also shared here:

Lymph Node Removal, also called a Sentinel Node Biopsy, may be recommended at the same time as the wide-excision to determine if the cancer has spread. The lymph node biopsy is usually performed if there are no concerns about enlarged lymph nodes before your surgery.

In order to identify the lymph node(s) a radioactive and/or blue dye must be injected into the area of the tumor or the skin just above the tumor. This dye will travel to the sentinel node(s) allowing your surgeon to identify and remove them. These lymph node clusters are most commonly in the axilla (armpit) and groin. At that point a small incision will be made to remove the first one or two nodes into which a tumor drains (sentinel nodes). Once removed, the incision will be meticulously closed with suture. The suture will all be under the skin, so there will be no stitches to remove after surgery. The nodes are then sent to be tested for cancer.

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If no cancer is present, no further lymph nodes need to be removed. If cancer is present, the surgeon will discuss options such as further lymph node removal or observation with or without additional treatments such as immunotherapy.

Lymph Node Dissection may be recommended if a previous lymph node biopsy shows signs of cancer. During this procedure your surgeon will make an incision to remove a number of lymph nodes most commonly located in the axilla (armpit) or groin. Once removed, the incision will be meticulously closed with suture. The suture will all be under the skin, so there will be no stitches to remove after surgery. A drain may be placed. If so, drain care instructions are attached here for your reference. The lymph node dissection may require an inpatient hospital stay depending upon the required procedure.

Recovery:

This varies from patient to patient and depending upon the location of the melanoma. You may have lifting and activity restrictions after surgery.

While recovery instructions may be tailored to individualize a plan of care based upon your specific needs, these instructions are common following melanoma removal surgery:

You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home.
When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.
Avoid fried foods, milk products and citrus juices for around one day after your surgery. Suggestions for foods to eat include soup, sandwich, pasta, potatoes, toast, and applesauce.
You may be able to shower within a couple of days after your surgery. If a drain is placed, you can reference the drain care instructions attached.
The dressings applied to your surgical site will be specific to your procedure. If surgical glue is used, there will be no dressings to remove. If bandages are applied, they can usually be removed at home in 24-48 hours. You will receive care instructions specific to your procedure.
You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Often times we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.
It is often suggested to start taking a stool softener twice daily the day following your procedure. You will want to continue this regimen as long as you are taking narcotic pain medications.

For additional information for after surgery preparation click here.

To Schedule an Appointment

To find out more about Melanoma Removal Procedures offered at CSA Surgical Center in Columbia, Missouri please call Columbia Surgical Associates at 573-443-8773 and schedule an appointment with a board-certified general surgeon.