Malignant Melanoma
What does a diagnosis of Melanoma mean for me?
Melanoma is a skin cancer arising from the pigment producing cells (melanocytes) in the skin. Although it often resembles dark or irregular looking moles or freckles on the skin it can also be red, pink or sometime clear in color. Some can even develop from previously existing moles.
Like many cancers, when melanoma is detected early it is usually almost always curable. However, If not detected early the melanoma can spread to other parts of the body and be fatal. Though it is not the most common skin cancer it is the most fatal one and is taken most seriously.
Risk factors for melanoma include excessive sun exposure, family history of the disease, having many moles yourself or many irregular looking moles (dysplastic nevi syndrome), being in an immune compromised state (due to illness, infection, medications and organ transplant recipients) and certain specific genetic mutations. People who are diagnosed with other skin cancers such as basal cell carcinoma and squamous cell carcinoma are also at an increased risk for developing melanoma.
The best protection against melanoma skin cancer is education! Wearing sunscreen, protecting our younger generations, avoiding indoor tanning and being as careful as we can when playing or working outdoors is our best defense against developing this form of skin cancer.
- Apply a broad-spectrum sunscreen of SPF 30 or higher 20-30 minutes before sun exposure.
- Re-apply sunscreen every 60-90 minutes while in the sun.
- Avoid peak hours of the sun between 10am and 2pm.
- Wear sun protective clothing.
- Do not burn!
- Avoid indoor tanning.
- Examine your skin once a month for new or changing spots.
- Have a yearly skin examination to ensure your skin is in good health.
The ABCDE's of Melanoma
One piece of advice I always try to stress to my patients is to always be on the lookout for any mole or growth that is new or changing in any way. Not all new growths or lesions that change are bad, but some are and the earlier these are identified the better the prognosis. The "ugly duckling" rule is one method that should be applied when examining your skin. Look for anything that stands out differently from the rest of the growths or moles that you see on your skin. A simple easy guide is what we call the ABCDE's of melanoma.
- A: Asymmetry - Most benign moles are symmetric - meaning that if you fold the mole in half onto itself each side should match. Many malignant moles appear to be asymmetric and do not have a consistent shape.
- B: Border - The borders or edges tend to be irregular and jagged in cancerous or abnormal moles. Many benign growths have very smooth borders and edges.
- C: Color - Most benign moles are made up of one color (usually a shade of brown). When a mole or growth appears to have many different colors in shades of brown and black it could be a warning sign that something is wrong with that mole.
- D: Diameter - Most benign moles tend to be smaller than malignant ones. Malignant or abnormal moles are usually larger than the size of a pencil eraser. However, when detected early they may be smaller than this size.
- E: Evolving - Most benign moles remain stable and unchanged over time. But when a mole or growth begins to evolve or change you should have it evaluated. Any change that occurs should be a warning sign to have the growth checked. Look for change in size, color, elevation, texture, or other traits such as itching or bleeding.
Self skin exams should be done once a month to evaluate for any of these changes. If you or someone else notices something out of place it is important that you do not delay in having it looked it. If you do not see anything to report, I still recommend an annual skin exam for a complete evaluation of your skin.
How is Melanoma treated?
Treatment of melanoma depends on the stage of melanoma at diagnosis. The first step in treating melanoma is complete surgical removal. Any further treatment would depend on many factors related to the stage.
- Melanoma In Situ: This is a very thin or superficial melanoma. The melanoma is still only found in the epidermis and has not reached down to the dermis (a deeper layer of skin). Complete surgical removal is the most effective way to cure this melanoma. Usually with any melanoma a wide margin is obtained to ensure all melanoma cells are removed. Most of the time this can be done in the office.
- Stage 1: This melanoma begins to reach a little further through the epidermis and closer to the dermis. For some Stage 1 melanomas complete excision with a wide margin of healthy tissue is all that is necessary. If the melanoma is a little deeper or ulceration is present, a sentinel lymph node biopsy* may be needed to ensure the melanoma has not begun to spread beyond the skin. If a lymph node biopsy is required you will be referred to an oncology surgeon that specializes in melanoma.
- Stage 2: A stage 2 melanoma has begun to extend deeper into the dermis (1mm - 4mm). These melanomas are now at risk of distant spreading depending on how far they extend into the dermis. Complete surgical removal with a wide margin of healthy tissue and sentinel lymph node biopsy* is required for all stage 2 melanomas and beyond.
- Stage 3: This melanoma usually extends through most of the dermis and to a few lymph nodes or to the tissue surrounding the melanoma. Their is usually no distant spread to any other organs. Complete surgical removal with a wide margin of healthy tissue is required for all stage 3 melanomas. Further therapy may also be required.
- Immunotherapy: Medications that help boost the body's ability to fight off certain diseases and cancer cells.
- Targeted Therapy: Medications that help the body identify specific types of cancer cells and attack the cancer cells or inhibit their growth and spread without killing healthy cells.
- Gene Therapy: Drugs that are used to help patients with a specific gene mutation (BRAF) to ward off melanoma cancer cells.
- Chemotherapy: Some treatments used to treat other cancers have been used in melanoma patients. However, these therapies are being phased out as newer, more specific targeted therapies are developed to treat melanoma.
- Radiation Therapy: While not often used as first line therapy, radiation therapy is being combined with other treatments to help control melanoma cells from returning after surgical removal and treat cases tha may have had many lymph nodes removed.
- Stage 4: Stage 4 melanoma is also known as metastatic melanoma. This melanoma has typically spread far outside from the original site. It spreads most commonly to the liver, lungs and brain. Complete surgical removal with a wide margin of healthy tissue is required for all stage 4 melanomas. Additional treatment is also necessary.
- Immunotherapy: Medications that help boost the body's ability to fight off certain diseases and cancer cells.
- Targeted Therapy: Medications that help the body identify specific types of cancer cells and attack the cancer cells or inhibit their growth and spread without killing healthy cells.
- Gene Therapy: Drugs that are used to help patients with a specific gene mutation (BRAF) to ward off melanoma cancer cells.
- Chemotherapy: Some treatments used to treat other cancers have been used in melanoma patients. However, these therapies are being phased out as newer, more specific targeted therapies are developed to treat melanoma.
- Radiation Therapy: While not often used as first line therapy, radiation therapy is being combined with other treatments to help control melanoma cells from returning after surgical removal and treat cases tha may have had many lymph nodes removed.
If you are diagnosed with melanoma I will be able to help guide you along this path of treatment. If you have an advanced stage of melanoma I will refer you to the best oncology surgeons to treat your advanced disease. After your treatment, it is recommended that you have close follow up every 3 - 6 months for continued surveillance of your skin and to screen for additional melanoma or recurrences.
*Sentinel Lymph Node Biopsy (SNL) is a procedure performed where a radioactive dye is injected near the primary source of melanoma. That dye is then tracked by a camera to follow where it drains to. The first few lymph nodes it goes to are then removed and tested for melanoma cells to determine if the melanoma has spread.