Why am I being operated on twice?

The first excision establishes the diagnosis and measures the exact thickness of the lesion; the second adapts the safety margins to that thickness, in accordance with guidelines. This is the normal, planned course of the surgical management of a melanoma.

Under what anaesthesia are these procedures performed?

The initial excision is most often performed under local anaesthesia. The wide re-excision, depending on its extent and any sentinel lymph node biopsy, may require general anaesthesia. Each situation is discussed at the consultation.

How quickly should I be operated on?

While not an immediate life-threatening emergency, the management of a lesion suspicious for melanoma should not be delayed: timescales are organised accordingly, in coordination with your dermatologist.

Is surgery always sufficient?

At the localised stage, surgery is the first-line treatment. Depending on the stage and the results of the analysis, other treatments may be discussed at a multidisciplinary team meeting — your team will inform you if applicable.

Melanoma

Melanoma is a skin cancer arising from melanocytes, the cells that produce pigment. It is rarer than carcinomas but requires prompt and rigorous management. At the localised stage, its treatment relies first and foremost on surgery.

Care is coordinated: the dermatologist detects the suspicious lesion and provides follow-up; Pr Ignacio Garrido performs the surgical stage — excision, re-excision with margins, reconstruction — in liaison with the team looking after you and, where the situation warrants it, within the framework of a multidisciplinary team meeting (MDT). This information is provided for general guidance and does not replace a medical consultation.

The role of surgery

Melanoma surgery classically involves two stages:

the initial excision: the suspicious lesion is removed in its entirety, with a limited margin, and sent to the laboratory. Histopathological analysis confirms (or rules out) the diagnosis and measures the thickness of the lesion (Breslow thickness), which guides everything that follows;
the wide re-excision: if the diagnosis is confirmed, a second procedure widens the margins around the initial scar, according to the measured thickness and current guidelines. This re-excision reduces the risk of local recurrence.

Why a second operation?

This is the most frequent question. The first excision serves to establish the precise diagnosis: the exact thickness of the melanoma is only known after analysis under the microscope. The definitive margins can therefore only be defined at that point. Operating in two stages makes it possible to match the extent of the procedure exactly to the reality of the lesion — neither too much, nor too little.

The sentinel lymph node

Depending on the thickness of the melanoma, sentinel lymph node biopsy (the first draining node of the area) may be proposed. This procedure, discussed at the MDT meeting, is performed in a specialised setting, most often at the same time as the wide re-excision. Its indication is explained to you on a case-by-case basis.

Reconstruction and the resulting scar

Re-excision with margins can create a defect requiring an adapted closure: direct suture, local flap or skin graft depending on the area. The objective is twofold: oncological safety first, then the best possible scar outcome. Experience in plastic surgery makes it possible to reconcile both, including in visible areas.

Procedure and recovery

Initial excision: most often under local anaesthesia, as day surgery.
Wide re-excision: under local or general anaesthesia depending on the extent and the area, generally also as day surgery.
Recovery: dressings for one to two weeks, moderate discomfort, a scar that evolves over several months with essential sun protection.

Follow-up

After a melanoma, regular and prolonged dermatological follow-up is systematic, at a schedule defined by your team according to the stage. Self-monitoring of the skin and scars, together with rigorous photoprotection, are part of it. Any new pigmented lesion that changes in size, shape or colour should prompt a consultation without delay.