Wide Local Excision

What is it?

If the biopsy after your local excision shows that you have melanoma, you will need to return to hospital to have a further operation.  This is called a wide local excision and is generally done under a local anaesthetic, but may be done under a general anaesthetic.  The doctor removes a large area of healthy skin and tissue from around where the melanoma was.  How much tissue you have removed depends on:

  • whether any of the melanoma cells were left behind in the surrounding skin
  • how deeply the melanoma has grown into the tissue beneath the skin
  • the position of the melanoma on the body
  • whether the surgery will affect your movement afterwards (for example, if the melanoma is close to a joint)

In the latest guidelines, the National Institute for Health and Care Excellence (NICE) recommend that:

  • for stage I melanoma, the surgeon removes 1 cm of tissue around the melanoma
  • for stage II melanoma, the surgeon removes at least 1cm or up to 2 cm of tissue around the melanoma

Wide local excision is usually a small operation. However, the surgeon will use stitches to close up the skin that has been removed and as a result the skin may feel tight at first but this should subside as it stretches. The surgery will leave a scar and its severity will depend on the amount of skin removed, the surgical technique and the location of the excision. The scar will be larger than the scar from the original excision.

Sometimes your surgeon needs to remove a large area of skin. This may not close directly, so an additional procedure is required to close the wound. Generally, your surgeon will try and close the area with a local flap, as it is more robust and has a better cosmetic appearance. Here, spare skin next to your wound is moved to close the wound and because it is ‘spare’ the area it came from can also be closed. If a flap is not possible then a skin graft will be required. The skin graft is taken from somewhere else on your body and used like a dressing. The graft sticks like a slow setting glue and needs to be looked after whilst it is sticking. Infection, bleeding or injury to the area can all affect how the glue sticks.

Risks and side effects

Like all surgery, wide local excision of melanoma carries risks, including poor scarring, infection, bleeding, pain and numbness. More specific side effects would be explained by your surgeon according to where the skin was removed.

More information on wide local excision can be found here.

Values you may wish to consider during treatment

    • How important is it to you to know the risk of your melanoma and its prognosis?
    • Do you want the treatment that is most likely to leave your daily life unaffected?
    • How much do you want to avoid having a visible scar after treatment?
    • How much time are you prepared to spend in hospital having treatment?
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