Private Melanoma & Soft Tissue Sarcoma Surgery for Canadians

It depends on your pathology report. A sentinel node biopsy is usually discussed when a melanoma is thicker than about 0.8 mm or is ulcerated, because those features raise the chance of spread to the nodes. Very thin melanomas generally don't need one. For melanoma on the head and neck, where drainage is harder to predict, mapping scans help the surgeon find the right nodes. A specialist review of your Breslow depth, ulceration and other findings will tell you whether it's recommended for you.

Not necessarily. Large studies have found that, for many patients, removing the remaining nodes in that area doesn't improve survival, and it raises the risk of side effects such as lymphedema. Close monitoring with ultrasound is now a common alternative, often alongside immunotherapy or targeted therapy. A full lymph node dissection is still recommended in some situations, such as when nodes can be felt or seen on imaging. Your surgical oncologist will weigh the size of the node deposit and your overall treatment plan.

This is more common than many people expect, and specialized sarcoma programs see it often. The usual next steps are an expert review of the original pathology slides, an MRI of the area and a CT of the chest. In many cases a second operation, called a tumour bed re-excision, is recommended to make sure the margins are clear, sometimes with radiation. We can gather your records and arrange a sarcoma specialist's review quickly.

For some patients, but not for everyone. Giving immunotherapy before surgery has become an option for certain people with stage III melanoma, particularly when lymph nodes can be felt or seen on scans. It isn't used for early-stage melanoma that can simply be excised. The decision is made by your surgical and medical oncologists together, and we coordinate the timing so surgery follows treatment without unnecessary delay.

Start with your pathology report. For melanoma, that includes Breslow depth, ulceration, mitotic rate and margin status. For sarcoma, it includes subtype and grade. Pathology slides or tissue blocks are valuable if a second pathology opinion is needed. Send imaging as actual images where possible, not just reports: MRI, CT, PET-CT or ultrasound. Operative notes from any earlier surgery and molecular results, such as BRAF status for melanoma, also help. If you don't have everything, we'll request it on your behalf.