Melanoma is a type of skin cancer. It starts in the cells called melanocytes that give skin a tan or brown color. Because of this, it often starts as a mole or dark spot on the skin. It spreads faster than many other types of cancer. It's important to get this treated because it can be life-threatening.

Melanoma is diagnosed with a biopsy. This is when a tiny piece of the abnormal skin is removed and tested for cancer cells. After a diagnosis is made, a larger area around the melanoma is also removed. This is called a wide local excision. If the cancer is found early, when it's small and hasn't spread, it has a high chance of being cured.

You may need a skin graft or flap to cover and replace the skin that is removed in surgery.

Lymph nodes are small clumps of tissue that are part of the body's immune system. If melanoma spreads, it often goes to nearby lymph nodes first.

The sentinel nodes are the first lymph nodes that tumor cells spread into. These are the first places that cancer is likely to spread. Depending on the thickness of your tumor, the sentinel nodes may need to be removed and checked for cancer cells. A sentinel node biopsy is a test that's often done during surgery to remove melanoma. This test helps the surgeon know which lymph nodes to remove. If you're going to have a sentinel node biopsy, your surgeon can tell you more about what to expect. Locating the sentinel lymph nodes (sentinel lymph node mapping) is best done before the wide local excision.

Sometimes lymph nodes can look swollen (enlarged) on an imaging test such as a CT scan or they can be felt during an exam. If you have these signs, a needle biopsy might be done to see if the lymph nodes contain melanoma cells. If they do, all of the lymph nodes in the area might be removed. This is called a lymph node dissection.

Risks and possible problems from melanoma surgery include:

• Bleeding.
• Infection.
• Scarring at the surgery site.
• Problems with the skin graft.
• Not removing all of the cancer, which may mean more treatment is needed.
• Risks of anesthesia.
• Fluid build-up and swelling in an arm or leg (lymphedema) if many lymph nodes were removed.

Get ready for the surgery as you've been told by your care team. Be sure to:

• Tell your doctor about all the medicines you take. This includes over-the-counter and prescription medicines, street drugs, marijuana, vitamins, herbs, CBD, and other supplements. It also includes any blood thinners or daily aspirin. You may need to stop taking some or all of them before surgery.
• If you're getting general anesthesia, follow the directions you are given for not eating or drinking before surgery.
• If you're having a sentinel node biopsy, you may be given an injection of harmless blue dye or a small amount of radioactive substance to locate the sentinel lymph nodes the day before surgery.

The surgery may take many hours, depending on what's done. You will likely go home the same day.

• An I.V. (intravenous) line may be put into a vein in your arm or hand. It's used to give you fluids and medicines.
• You'll be given medicine to keep you from feeling pain during surgery. If the surgery is done to remove a smaller skin tumor, you might only need local anesthesia. For more complicated cases, you may also be sedated, which makes you relaxed and sleepy. For the largest procedures, you may need general anesthesia, which puts you into a deep sleep. A tube may be put into your throat to help you breathe. The surgeon or anesthesiologist will discuss your choices with you.

• If a sentinel node biopsy will be done, a harmless blue dye or a small amount of radioactive substance is injected into or near the tumor. This helps the doctor find the lymph nodes where cancer may have spread.
• A cut (incision) is made at the tumor. The tumor is removed along with some of the normal tissue around it. This helps make sure that any cancer cells that may have spread to nearby skin are removed.
• One or more lymph nodes near the tumor may be removed. These are checked for cancer cells (a sign that cancer has spread).
• The incision may be closed with stitches or staples. In some cases, a skin graft or flap may be needed to help close the site. This can come from your own body, a donor, or manmade sources. The doctor will discuss the different types of grafts with you before the surgery.

If you had only local anesthesia, you can go home shortly after surgery. If you had general anesthesia, you'll be taken to a recovery room to wake up. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You'll be given medicine to manage pain. When it's time for you to go home, you'll need an adult family member or friend ready to drive you.

After you are back at home, follow the instructions you've been given. Your doctor will tell you when you can return to your normal routine. Be sure to:

• Take all your medicines as directed. Be sure you know how to use your pain medicine and what side effects you should watch for.
• Care for your incision as instructed.
• Don't do heavy lifting or strenuous activities, as directed.
• Don't drive until your doctor says it's okay. Don't drive if you're taking medicine that makes you sleepy or drowsy.
• Follow your doctor's guidelines for showering. Don't swim, take a bath, use a hot tub, or do other activities that cover the incision with water until your doctor says it's okay.

Contact your doctor right away if you have:

• Chest pain or trouble breathing (call 911).
• A fever of 100.4° F (38°C) or higher, or as directed by your doctor.
• Chills.
• Symptoms of infection at an incision site, such as increased redness or swelling, warmth, worse pain, or drainage.
• Problems with the skin graft or flap.
• Pain that can't be controlled with medicine.
• Warmth, redness, or swelling in an arm or leg.

Be sure you know how to reach your doctor any time you need help, including after office hours and on weekends and holidays.

You will have follow-up visits so your doctor can see how well you're healing. If needed, stitches or staples will be removed at one of these visits. You and your doctor can also discuss next steps and other treatments you may need.