Melanoma

What is it?

Melanoma is a tumor of the skin that is malignant (cancerous). It originates from melanocytes, which are the cells that color the skin. The incidence of melanoma is increasing worldwide at a rate of about 5% per year. It is more serious than the more common skin cancers like basal cell or squamous cell cancer. This is due to the fact that melanoma often will spread to other parts of the body. Melanoma can spread through the lymphatic system or through the bloodstream. Risk of relapsing decreases over time, but late relapses are not uncommon.

Melanoma is the type of skin cancer that will kill a patient if it spreads throughout the body or if it is left untreated. It is very important that patients that have been diagnosed with melanoma follow their dermatologist’s recommendations very closely.

What does it look like?

Melanoma may appear as a new mole on the body or as a mole that has changed in size, shape, feeling, color, or has developed oozing or bleeding. Men most often get it on the trunk, especially between the shoulder blades or on the head or neck. Women most often get it on the arms or legs. However, it is important to remember that melanoma can occur anywhere on the body. Most appear dark but can be flesh colored or pink to red. Remember to look for the ABCD’s of melanoma (A=Asymmetry, B=Border irregular, C=Color is varied throughout lesion, D=Diameter greater than 6 millimeters).

How is it diagnosed?

If there is question of skin cancer, the area should be removed. Skin pathologists will then analyze the skin. If found to be a melanoma, the lab will report how deep and aggressive it appears. Further physical exams including lymph nodes exams, radiology studies (x-rays) and lab tests will be done to look for signs of cancer cells spreading. This is called staging. It is most advanced if the growth extends deeper than 4 millimeters (which is less than 1/16 of an inch) into the skin. Even worse are melanomas that spread to the body tissue below the skin, show additional tumor around the original site, or have spread to the lymph nodes or other organs.

What is the treatment?

Surgery is the primary treatment of all stages of melanoma as the other treatments for melanoma are many times very unsuccessful. After the initial biopsy, a second surgical procedure is normally done to ensure complete removal. Usually, the biopsy site and rim of normal skin are removed (re-excision). Complete removal before it has spread is the only sure cure.

Occasionally during the staging process, a procedure called a sentinel lymph node biopsy (SLNB) may be needed. This allows for more accurate staging but it has not been determined whether or not it helps in long term prognosis. It is usually reserved for those patients with melanomas deeper than 1mm in depth or that have other special characteristics.

Other treatments that may be used but which are not as successful include chemotherapy, radiation, and immunotherapy. Chemotherapy uses drugs to kill cancerous cells but may not be very effective. Radiation uses x-rays to kill the cancerous cells and shrink tumors, but it usually does not cure the patient. Some types of melanoma may need special types of radiation. Advanced tumors may also require removal of affected lymph nodes, followed by chemotherapy. Some newer treatments may also be used to help the immune system itself fight the cancer. These melanoma vaccines may also provide some hope.

In addition, patients need to become actively involved in their care and should do two sets of things: (1) monthly self skin and lymph node exams including having a spouse or significant other examine those areas that cannot be seen by the patient and (2) sun safety precautions including the following:

  • Seek shade between 10:00 A.M. to 4:00 P.M. when the ultraviolet rays are the most intense, especially when your shadow is shorter than you are tall.
  • Wear light-colored, tightly-woven, protective clothing, and wide-brimmed hats (3-inch brim).
  • Apply sunscreens with a SPF (Sun Protection Factor) of at least 30 with both UVA and UVB coverage. Some good sunscreens include Ombrelle ® SPF 30 and SPF 60, GlyDerm ® Super Sunblock SPF25, and Neutrogena ® UVA/UVB Sunblock SPF30 and 45.

What is the Prognosis?

Determining prognosis in melanoma is sometimes difficult due to the many factors that influence how well a patient does. The most reliable, time-tested method of suggesting prognosis is the depth of invasion of the melanoma.

For those patients with “in-Situ (confined within the top layer of skin)“ melanoma, surgery usually leads to 5 year survival rates in patients in 95-99% of the cases. For these patients, they are essentially cured from their surgery. If the melanoma is not confined to the top layer of skin, but has invasion that is less than 1mm in depth, 5 year survival rates are still very high at 85-90%. For those melanomas greater than 1mm in depth, 5 year survival rates are not as high and are clearly influenced by whether or not the melanoma has already spread to other parts of the body.

Overall, melanoma is a very serious disease if not the most serious in dermatology. It is a disease that can kill patients if not diagnosed early and treated appropriately. It is vital that you follow your dermatologist’s recommendations very closely.