Wide local excision

Patient Guide

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 an 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 where the area is numbed with a local anaesthetic and you will generally go home on the same day. The surgeon or plastic 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 and may take longer to heal.

If the surgeon thinks that the wound won’t close easily with stitches, they may need to use a skin flap or skin graft. Generally, your surgeon will opt to 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 where your surgeon will remove some skin from somewhere else on your body and use it 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.  

You will usually go home on the same day and you will be given information on how to take care of the wound and dressing. If you have a skin graft, you will have two wounds and two dressings to look after when you go home. The skin from your skin graft will grow back quite quickly if it is not knocked or damaged.

A procedure called a sentinel lymph node biopsy may also have been discussed with you and if you have this procedure, it will be done at the same time as the wide local excision. For information on sentinel lymph node biopsy and our animated videos, see here.

Risks

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.

What happens next?

A pathologist (a specialist doctor) will examine under a microscope this extra area removed from around your melanoma and look for melanoma cells. Your medical team are gradually building up a picture of the extent of your melanoma which is also called the ‘stage’ of your melanoma. To understand melanoma staging, see melanoma staging explained.  

Once the information has been examined and reviewed, you will be invited back for an appointment to discuss the results of your surgery.

We know that waiting for any results and additional information is a worrying time for you and your family. If you would like to discuss your concerns, please call our:
Melanoma Helpline on 0808 801 0777

Questions you may have

  • Can I exercise after my wide local excision?
  • How long will the results take to arrive back?
  • How will I get my results?
  • Will I have a visible scar and what can be done to minimise the scarring?
  • What may happen next?
  • What is the stage of my melanoma and do I need further treatment?
  • How will I be followed-up after my surgery?