What to Expect: Excisional Surgeryby Eileen Bailey Health Writer
For melanoma up to stage 2, doctors often recommend a wide excision. This type of surgery is sometimes used for basal cell and squamous cell carcinoma, however, Moh's surgery is sometimes recommended for those types as there is a higher cure rate although excision has a success rate of around 90 percent. Wide excision removes the tumor as well as some of the surrounding skin (usually ½ to 1 inch) to make sure there is no cancer left.
Wide Excision Surgery
Your doctor will draw a shape around the lesion being removed. This shape is often in the shape of a football as this is easiest to close after the surgery. He then removes the entire growth, and some area around it, with a scalpel. Once the excision is complete, your doctor will close the area with stitches. The removed tissue is sent to a laboratory for testing. The surrounding tissue is tested as well. If cancer is found in the outermost points, your doctor may recommend further treatment.
Before Your Surgery
Many excision surgeries are done with a local anesthesia, however, your doctor may request that you not eat anything after midnight the day prior to your surgery. Be sure to follow any instructions your doctor gives you.
Be sure to talk with your doctor about any medications you are taking, including any over-the-counter medications, vitamins and herbal supplements. Some medications, for example Aspirin or ibuprofen, increase bleeding and should be discontinued one to two weeks prior to your surgery. If you aren't sure if you should discontinue a medication, talk to your doctor or pharmacist about the ingredients.
Smoking can impact your healing time. It is recommended that you quit smoking and remain smoke-free for at least one week after your surgery.
After Your Surgery
When your surgery is complete, the doctor will apply a dressing to the wound. Keep this dressing in place for 48 hours unless your doctor tells you otherwise. It should not get wet.
To minimize swelling and pain, apply an ice pack to the area for 20 minutes at a time every one to two hours. You can continue to apply ice for 48 hours.
Your doctor may have prescribed you pain medication. Take this medication as directed. You can also take extra strength Tylenol and ibuprofen to reduce the pain. If you have liver problems, you should not take Tylenol. If you have kidney problems, you should not take Advil.
You may notice some bleeding on your dressing. A small amount of bleeding is normal.
A low-grade fever, up to 101 degrees, is normal.
You may feel itching or tingling during the healing process. This is normal.
After 48 hours, clean the wound (3 percent peroxide is often recommended) with Q-tips. Apply petroleum jelly to the stitches with Q-tips and apply a clean, non-stick gauze over the wound.
When you are able to change the dressing, you are able to shower but keep the dressing in place and when done, apply clean, dry gauze - applying the petroleum jelly to the stitches first.
Things you shouldn't do after surgery: don't drink or take any herbal supplements for several days. Don't bend, lift or exercise for one week. Don't smoke for one week. Don't lift weights for two weeks.
When to Call the Doctor
Although most surgeries heal with only a little discomfort, there are times you should contact your doctor. If you experience any of the following, call your doctor right away:
Bleeding that fills the bandage
Drainage from the wound that doesn't stop even after you have applied pressure for 20 minutes
A fever of higher than 101 degrees for more than 24 hours
Redness or swelling that spreads outward from the wound
Pain that doesn't respond to pain medication or sharp, shooting pains
Nausea or vomiting
"Treatment Handbook: Melanoma Surgery," Staff Writer, Comprehensive Cancer Center Surgical Oncology Division & Patient Education Program, Medical Oncology