Reconstructive surgery after melanoma

When melanoma is surgically removed, it can leave behind more than just a scar. Depending on the location and size of the tumour, it may also result in changes to your appearance and function.

In this article, consultant plastic surgeon Mr Jonathan Dunne explains the key reconstructive options available to help restore both form and function following melanoma surgery.

Why might reconstruction be needed after melanoma surgery?

Melanoma surgery typically involves removing the cancerous lesion along with a margin of healthy skin to ensure all cancer cells are eliminated.

In more advanced cases, deeper layers of tissue like fat, muscle, or fascia may also be removed. This can result in noticeable changes, particularly when the melanoma is located on the face, limbs, or near joints.

For many patients, the resulting changes in appearance can have a profound impact on self-esteem. Reconstructive surgery plays a crucial role in helping patients regain both confidence and comfort in their daily lives.

What are the main reconstructive techniques?

Several surgical techniques can be used to restore the area after melanoma removal, depending on its size, location, and complexity.

1. Direct (primary) closure

If the wound is relatively small and the surrounding skin is flexible, the edges may be gently brought together and stitched. This offers minimal scarring and a straightforward recovery.

2. Skin grafts

Skin grafting involves transferring a thin layer of skin from a donor site on the patient’s body to cover the surgical wound.

Split-thickness grafts include the top layers of skin and are commonly used for larger areas, such as the scalp or limbs.
Full-thickness grafts, which include all layers of the skin, are more appropriate for areas where colour and contour match are essential, typically the face.

Grafts do not bring their own blood supply, so they rely on the health of the surrounding area to successfully heal and integrate.

3. Local flap reconstruction

In cases where appearance is especially important, nearby skin and tissue (still attached to its own blood supply) is used to cover the wound. Known as a local flap, this technique offers superior cosmetic outcomes as it closely matches the colour, texture, and thickness of the treated area. It’s frequently used in facial reconstruction (nose, lips, and eyelids).

4. Free tissue transfer (free flap surgery)

In more complex situations, tissue from a distant site such as the thigh or back can be transplanted, along with its blood vessels, to the affected area. Microsurgical techniques are used to connect the vessels to the local blood supply. Free flap surgery is typically considered when there’s a need to reconstruct deeper structures or restore significant volume.

How is the best reconstructive option chosen?

Each reconstruction plan is tailored to the individual. Factors such as the size, depth, and location of the melanoma, overall health status, and aesthetic priorities are all considered. The goal is to balance optimal cancer removal with a thoughtful, functional, and cosmetically sensitive reconstruction.

Timing: Immediate vs delayed reconstruction

Reconstruction may be performed at the same time as the melanoma removal (immediate reconstruction), or after confirmation of clear margins (delayed reconstruction). Each approach has advantages, and the choice is made collaboratively between patient and surgical team.

While melanoma surgery can be physically and emotionally challenging, modern reconstructive techniques offer patients an excellent chance to regain both form and function.

Whether your concerns are cosmetic, practical, or both, discuss your options with Mr Dunne to ensure that your recovery is as complete and confidence-restoring as possible.