Melanoma Surgery and Treatment

Melanoma is a type of skin cancer that often begins as a subtle change in the skin and develops quickly if not detected early. Recognising changes in your skin and seeking timely care can make a significant difference in treatment outcomes. Surgery is often the first step, and depending on the situation, other therapies may follow. Understanding your options can help you feel more informed and prepared as you explore the treatment process.

What Is Melanoma?

Melanoma is a form of skin cancer that begins in the cells that produce melanin, the pigment that gives skin and hair their colour. While defined as the most serious type of skin cancer, melanoma is easily curable when detected early, having a 5-year survival rate of up to 99%. Left untreated, the cancer can spread to the lymph nodes and nearby organs.

Who Is At Risk of Melanoma?

Certain factors contribute to a heightened risk of developing the condition:

• Repeated and prolonged UV exposure and sunburn from natural sunlight or artificial sources such as tanning beds
• High number of moles or unusual moles
• Fair skin that indicates less melanin, which protects the skin from damaging UV rays

Additionally, older age and a family history of melanoma also increase one’s risk of skin cancer.

What Are the Signs and Symptoms of Melanoma?

Melanoma is mainly characterised by the appearance of unusual growths and pigmentations, and significant changes in existing moles.

The ABCDE guide is a useful way to assess whether a mole may need further evaluation:

• Asymmetry - One half of the mole does not match the other half
• Border - Edges are uneven, blurred or jagged
• Colour - Multiple colours or uneven shading within the mole
• Diameter - Larger than 6mm (about 1/4inch)
• Evolution - Any change in size, shape, or colour over time

Other warning signs can include itchiness, swelling, oozing or bleeding, and sores that do not heal. Consulting a melanoma doctor in Singapore can provide a professional assessment and confirm whether a mole or pigmentation is cancerous.

How to Reduce the Risk of Melanoma

While not all cases of melanoma can be prevented, adopting simple habits can help lower your risk:

• Avoid sun exposure during peak sunlight hours
• Apply broad-spectrum sunscreen before going outdoors and wear protective clothing such as long sleeves and hats
• Refrain from using tanning beds or sun lamps
• Conducting regular skin and mole assessments for signs of changes

How Melanoma Is Diagnosed

Melanoma diagnosis today is more accurate and effective thanks to advanced techniques and careful evaluation. Key components include:

• Early Detection: Most melanomas are identified at an early stage by a melanoma specialist. Early diagnosis is associated with high long-term survival rates and better treatment outcomes.
• Advanced Imaging: Techniques such as PET/CT and SPECT scans have improved the accuracy of staging. These scans help doctors plan precise and effective treatment tailored to each patient.
• Sentinel Lymph Node Mapping and Biopsy: This procedure helps determine whether melanoma has spread to nearby lymph nodes.
• Surgical Evaluation of Advanced Melanoma: For advanced cases, radio-colloid directed sentinel lymph node biopsy is performed, followed by full nodal dissection when necessary.

Melanoma Surgery

Melanoma can sometimes be managed with non-surgical treatments such as topical therapy, targeted medication or radiation. However, surgery remains the most definitive treatment in many cases. The goal of surgery is to remove the cancerous lesion along with a margin of healthy tissue. This helps ensure complete removal while reducing the risk of recurrence, giving you the best possible outcome.

Types of Melanoma Surgery

Depending on the stage and location of the melanoma, there are two common surgical procedures used to manage melanoma effectively. These include:

• Wide Local Excision

  Wide local excision removes melanoma along with a margin of surrounding healthy tissue. Removing this extra tissue helps clear any microscopic cancer cells near the tumor and reduces the risk of local recurrence. This procedure is most commonly used for early-stage melanoma, stages 0 to 2, where the cancer is confined to the skin.

• Lymph Node Dissection

  Lymph node dissection is performed when melanoma has spread to nearby lymph nodes, often determined by a sentinel lymph node biopsy. The surgeon removes one or more lymph nodes to control the disease and prevent further spread. This procedure is more extensive and is sometimes necessary for intermediate or advanced stages of melanoma (stages 3-4).

Recovery After Melanoma Surgery

Recovery after melanoma surgery depends on the type of procedure and the amount of tissue removed. For wide local excision, most patients recover within one to two weeks. During this time, the wound gradually heals. Following wound care instructions and activity guidance is essential for a smooth recovery.

Lymph node dissection typically requires a longer recovery, often four to six weeks or more. Because this procedure affects the lymphatic system, patients need closer monitoring and additional precautions to manage swelling and support proper healing.

• Pain Management – Mild to moderate discomfort is common after surgery. Your doctor may prescribe pain medication or recommend over-the-counter options. Follow your surgeon’s instructions carefully to ensure safe and effective pain control.
• Infection Monitoring – Watch for increased redness, warmth, swelling, or pus around the surgical site. Contact your doctor promptly if any of these signs appear.
• Follow-up Appointments – Regular follow-up appointments with your oncologist or surgeon can assess your recovery progress, remove stitches if necessary and discuss the results of the pathology report.
• Activity Restrictions – Some activities, including exercise, driving, or showering, may be temporarily restricted to allow proper healing. Your surgeon will advise when it is safe to resume normal activities.

Why Choose Our Melanoma Specialist in Singapore?

When you choose Dr Dennis Lim for melanoma care, you can expect:

• Extensive experience in managing melanoma, skin cancers, and complex head and neck conditions
• Management for all stages of melanoma from early detection to more advanced cases
• Care guided by evidence-based surgical techniques to ensure safe and effective outcomes
• Personalised treatment plans tailored to your diagnosis, needs, and goals

Frequently Asked Questions About Malignant Melanoma

• Is the diagnosis of malignant melanoma a ‘death sentence’?

  No. Most melanomas are detected early and can be effectively treated with surgery. Prompt assessment and treatment significantly improve outcomes and long-term prognosis.

• What about late-stage malignant melanoma?

  Advanced melanoma requires a comprehensive approach. This often involves imaging, biopsies, and careful staging to determine the most appropriate treatment plan tailored to the patient’s condition.

• What if the sentinel lymph node is positive for malignant melanoma?

  If cancer cells are found in the sentinel lymph node, a more extensive procedure called nodal basin dissection may be recommended. This involves removing all the lymph nodes that drain the area of the primary melanoma. The surgery is both therapeutic and informative, helping guide whether additional treatments are needed.

• What is a SPECT scan?

  SPECT (single photon emission computed tomography) combines a conventional gamma camera with CT imaging to produce detailed 3-dimensional images. It allows precise localisation of sentinel lymph nodes, which is crucial for surgical planning.

• Should I have all pigmented lesions removed?

  Not necessarily. A dermatologist can advise which lesions should be excised and which can be safely monitored with regular follow-ups. Decisions are made based on the appearance, size, and risk profile of each lesion.

• How much does melanoma surgery cost in Singapore?

  Costs vary depending on the stage of the melanoma, the complexity of the surgery, and any additional treatments required. A consultation with a specialist can provide a personalised cost estimate and treatment plan.