Introduction

The information in this guide will help you get ready for your wide local excision and sentinel lymph node biopsy surgery. It has information about what will happen on the day of surgery and how to manage your care after surgery.

Your surgeon and Sunnybrook nursing staff will go over this guide with you.

We know this may be a stressful time for you and you will be given a lot of information about your medical condition. This guide will help you keep track of what you need to do for your wide excision and sentinel node biopsy surgery.

Your medical records are accessible online through MyChart, a service available to Sunnybrook patients. In order to use MyChart you will need a password, which can be picked up at the Medical Records Desk on the second floor of the Odette Cancer Centre (Room T2-212). You can also get a password by completing the form on this webpage. The website address for MyChart is mychart.ca

• A wide local excision is a surgery that removes a 1 to 2 centimetre area of skin around the melanoma or other skin cancer. No muscle is removed with the surgery.
• The purpose of this procedure is to lower the chance of the skin cancer coming back in that spot where it was first found.
• Stitches or staples will be used to put the skin back together after the skin cancer is removed. The stitches will be taken out by your surgeon at your after-surgery appointment, approximately 3 weeks after the surgery.
• Your wide local excision surgery may also include other procedures such as a sentinel node biopsy and/or a skin flap or skin graft. (Please see separate booklet for more details on skin grafts.)

• Sometimes after removing the skin with the melanoma or other skin cancer, it is difficult to bring the skin edges back together (it is too tight). Examples of where this can be difficult include the hand, the lower part of the leg or the middle of the back.
• To bring the skin edges back together, your surgeon may do a "skin flap". A skin flap is a surgical procedure where the skin around the excision is strategically cut and shifted so that the skin edges can close. This will make your scar look bigger and may be in an unusual shape. Flaps are done at the same time as the wide local excision.
• Sometimes a drain is put under the flap so fluid does not build up underneath. If you have a drain, your surgeon will arrange for a nurse to help you with drain care. A nurse will come to your home or you will be asked to go to a wound care clinic. You will have skin stitches and/ or staples to close the flap. Your surgeon will remove the sutures at your after surgery visit.

• If your surgeon cannot bring the edges together with a flap, a plastic surgeon may do a skin graft at the time of your wide local excision. A skin graft is created from the top layers of skin removed from somewhere else on the body. The graft is used to close the skin where the surgery was done. (Please see separate booklet for more details.)
• If there are any questions about the skin graft, please contact Dr. Snell or Dr. Lipa (plastic surgeons).

• Lymph nodes act as filters in the body's circulatory system. Sentinel lymph nodes are the first lymph nodes that drain the area where the melanoma was found. For example, if the melanoma was on the arm, the nearest or first lymph nodes would be in the armpit. If the melanoma was on the leg, the first lymph nodes would be in the groin. For melanomas on the body or trunk, the nearest lymph nodes can be in the armpit or the groin.
• To identify the exact location of the sentinel nodes for your melanoma, the radiologists (doctors) inject a radioactive dye around the melanoma or the scar if the melanoma was removed, and an x-ray called a lymphoscintigram is taken. As part of your procedure, the surgeon will remove 1 to 3 sentinel lymph nodes from wherever they are shown on the lymphoscintigram.
• A blue dye may also be injected around the melanoma when you are asleep in the operating room to help your surgeon find your lymph nodes.

• Sometimes cancer cells leave the melanoma and spread to other parts of the body.
• Some of these cells will be caught in the lymph nodes.
• The surgeon needs to take out a few lymph nodes for testing.
• This information helps the doctors decide what other treatments you will need.