Melanoma Surgery | Brisbane & Redland

Expert melanoma care in Brisbane

Melanoma surgery is the surgical removal of a melanoma with a measured margin of healthy skin — called a wide local excision — and, for some melanomas, a sentinel lymph node biopsy to check whether it has begun to spread. Dr Goutham Sivasuthan, a Brisbane general surgeon, provides surgical treatment of melanoma and coordinates care with the wider melanoma team.

Melanoma is the most serious common skin cancer because it can spread, but when found early it is highly curable — five-year survival for thin, early melanoma is around 90%. Australia has the highest melanoma rate in the world, so prompt, complete surgery matters. For non-melanoma skin cancers see skin cancer surgery; for an undiagnosed pigmented spot, start with mole and skin lesion removal.

What causes melanoma?

Melanoma develops when pigment-producing skin cells (melanocytes) are damaged — most often by ultraviolet (UV) radiation from the sun or solariums — and begin to grow out of control. It can arise in an existing mole or appear as a new spot on previously normal skin.

Risk is higher with fair skin, a history of sunburn, many moles or atypical moles, a family or personal history of melanoma, and increasing age — though melanoma is also one of the more common cancers in younger Australians. Understanding your risk is a reason to check your skin regularly and act quickly on any change.

Signs and symptoms — the ABCDE rule

The ABCDE rule is the simplest way to recognise a melanoma. Have a spot checked promptly if it shows any of these features:

• Asymmetry — one half does not match the other.
• Border — irregular, ragged or blurred edges.
• Colour — uneven colour, or several colours (brown, black, red, white, blue).
• Diameter — larger than about 6 mm, although melanomas can be smaller.
• Evolving — any change in size, shape or colour, or a new spot that itches or bleeds.

The most important single sign is change. A new or changing spot in an adult — especially the "ugly duckling" that looks different from your other moles — should be examined without delay.

Diagnosis and staging

Melanoma is diagnosed by removing the suspicious lesion (an excision biopsy) and examining it under the microscope. The pathology report measures the melanoma Breslow thickness — how deep it has grown — which is the single most important factor in planning treatment.

Thickness, together with other features such as ulceration, determines the stage of the melanoma and guides both the surgical margin and whether a sentinel lymph node biopsy is recommended. For thicker or higher-risk melanomas, staging scans and review by a multidisciplinary team (MDT) help tailor the plan to you.

Wide local excision (surgical treatment of melanoma)

Surgery is the main treatment for melanoma, and the standard operation is a wide local excision (WLE): after the melanoma is diagnosed, the site is removed again with a wider margin of healthy skin around and beneath it, to clear any cells that may have spread microscopically.

The width of the margin is set by the melanoma Breslow thickness, following Australian clinical guidelines — broadly:

• Melanoma in situ (confined to the surface): a margin of around 5–10 mm.
• Thin melanoma (≤1 mm): a margin of about 1 cm.
• Thicker melanoma (>1 mm): a wider margin, typically 1–2 cm.

Smaller excisions are done under local anaesthetic; larger ones, or those needing reconstruction or a sentinel node biopsy, are performed under general anaesthetic on a day-surgery list. The wound is usually closed directly, sometimes with a flap or graft, and everything removed is checked by pathology to confirm clear margins.

Sentinel lymph node biopsy

A sentinel lymph node biopsy (SLNB) is a procedure to check whether melanoma has begun to spread to the nearest lymph nodes. It is offered for melanomas above a certain thickness (generally thicker than about 0.8–1 mm, or thinner ones with higher-risk features) and is usually done at the same time as the wide local excision.

The "sentinel" node is the first node the melanoma would drain to. It is identified using a tracer, removed and examined. If it is clear, the chance of spread is low; if melanoma is found, it informs further treatment and surveillance, often with input from the melanoma MDT. SLNB is a staging tool — Dr Goutham will explain whether it applies to your melanoma and arrange it where indicated.

Post-surgical care and follow-up

Recovery from a wide local excision depends on the size and site, but most people are home the same day and back to light activity within a few days. Sutures are removed at about 7–14 days, and you will receive written post-operative care instructions.

Because melanoma can recur and because having had one melanoma increases the risk of another, ongoing surveillance is essential. This means regular skin checks and, for higher-stage melanoma, scheduled review (and sometimes scans) coordinated with your GP, dermatologist and the melanoma team. Early detection of any new or recurrent lesion keeps treatment simpler.

Protecting your skin

Most melanomas are linked to UV exposure and are largely preventable. In the Queensland sun, protect your skin with clothing, SPF 50+ sunscreen, a hat, shade and sunglasses, and never use solariums.

Combine sun protection with regular skin checks — know your own moles, watch for change, and have a professional skin examination, particularly if you are fair-skinned, have many moles, or have a personal or family history of melanoma. Finding melanoma early gives the best possible outcome.

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