The Day of Surgery

Where do I check in?

• When you get to the hospital, check in at the Surgical Services Registration Desk. It is in M Wing, Ground Floor, Room 502 (MG 502).
• Bring your Ontario Health Card and your Sunnybrook card.
• You will be given a locker space to store your clothes and personal items, such as eye glasses.

How many family members or friends can come with me on the day of surgery?

• Please bring ONLY 1 person with you to the hospital. Your companion will be asked to stay in the waiting room until you are ready for surgery. The person can then be with you until you are called for surgery.
• During your surgery, your family member or friend can wait in room MG 502. 

• As part of your wide local excision, the surgeon will take out sentinel lymph nodes that are seen on the lymphoscintigram.
• The lymph nodes need to be specially identified before your surgery. This identification is called a Sentinel Lymph Node Injection.
• The injection takes place in the Department of Nuclear Medicine either the day of or the day before your surgery. The department is in A Wing, Ground Floor, Room 21 (AG 21).
• You will be given a map showing the location when you check in at the Surgical Services Registration Desk in M-Wing, Ground Floor, Room 502 (MG 502).
• The appointment can take up to an hour.

What happens during the sentinel lymph node injection?

• The sentinel nodes are specially identified so the surgeon can find them.
• This is done by injecting a small amount of radioactive tracer around the melanoma (or the scar if the melanoma was removed).
• The tracer travels to the sentinel lymph nodes.
• The amount of radiation that the tracer gives off is very little. It will not harm you.

How do I get ready for the injection?

• The injection is made into the skin around the melanoma or the scar (if the melanoma was removed) and may sting.
• You may want to use EMLA cream and Tylenol (acetaminophen) to help reduce any pain or discomfort.
• You can buy EMLA cream at a pharmacy. You do not need a prescription.
• Up to 1 hour before your appointment, put the cream outside the melanoma or the scar where the melanoma was located.
• You can take some Tylenol (acetaminophen) up to 30 minutes before the injection (DO NOT take Tylenol if you are allergic to it).
• Please DO NOT take Aspirin (acetylsalicylic acid or ASA) because it may increase bleeding from surgery.

After all your pre-surgery appointments, you will be taken to the Same Day Surgery Unit. Nurses will do the final checks and an intravenous (IV) will be started in your hand. You will then be brought into the operating room.

What will happen during my surgery?

• Several monitors will be placed on your body to check your heart and lungs during surgery.
• You will be put to sleep using a general anesthetic. Medication to make you sleep will be given through an intravenous needle.
• A tube will be placed in your throat after you are asleep to help you breathe.
• A 1 to 2 centimetre cut will be made around the melanoma, or scar, and the skin and fatty tissue will be removed. No muscle is removed.
• Some of the sentinel lymph nodes will also be removed. This is called a sentinel lymph node biopsy.
• To find the nodes, the surgeon will use a probe that locates the radioactive tracer that was injected before your surgery.
• The surgeon may also use a blue dye to find the sentinel lymph nodes. This procedure is done in the operating room while you are asleep under general anesthetic.
• The surgeon injects the blue dye around the melanoma or scar using a needle. The dye travels to the nearby sentinel lymph nodes and helps the surgeon to see them more clearly. It is possible that the sentinel lymph nodes may be removed from more than one area on your body (for example, armpits on both sides).
• All the tissue that is taken out will be sent to a lab to be examined by a pathologist (a doctor).
• The wide local excision cut is closed with stitches or staples on the outside of the skin. These will be removed in clinic 3 weeks after the surgery by the surgeon. The sentinel lymph node biopsy cut is closed with dissolving stitches.
• Paper skin tapes (called Steri-Strips) are usually put over the cut for the sentinel node. A dressing, or bandage, is then placed over the skin tapes.
• For the wide local excision cut, a dressing is placed over the stitches.
• The results from the surgery will take 2 to 3 weeks to be available. Your surgeon will discuss the results at your follow-up appointment.

What happens after my surgery?

• You will be taken to the recovery room.
• When you wake up you will be moved back to the Same Day Surgery Unit in Room MG 601.
• A nurse will call your family member or friend to come and visit you.
• You will continue to rest and recover. The nurses will start to get you ready to go home.

When will I see my surgeon for a follow-up appointment?

• An appointment will be made for you to see your surgeon 2 to 4 weeks after your operation.
• The surgeon will check how your wound is healing.
• Your surgeon will discuss the results of the tests done on the tissue removed during surgery. Any further treatment options will also be discussed.