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Melanoma


General Information

 

Melanoma is a type of skin cancer. It comes from the cells in the skin that produce pigment called melanocytes. Melanoma is a potentially deadly skin cancer. Fortunately, it can usually be treated effectively if it is identified and treated in its early stages.


What is the prognosis for melanoma?

 

The prognosis for melanoma depends on the stage of the cancer at the time of diagnosis. The stage of the cancer is based on features of the melanoma, such as its thickness, and whether or not there is any evidence of melanoma elsewhere in the body. For more detailed information on melanoma staging refer to the links at the end of this sheet.

 

The most important factor associated with survival in patients with melanoma is the thickness of the melanoma. Thickness is most commonly reported as a measurement of depth given in millimeters (mm). This measurement of thickness is called the Breslow’s depth. Sometimes the thickness is reported in a different way called the Clark’s level. Clark’s levels are designated with the roman numerals I through V, with I being the thinnest and V being the thickest.

 

In general the thicker the melanoma is, the worse the prognosis. Some melanomas are designated as melanoma in situ. “In situ” means that the melanoma is limited to the uppermost portion of the skin called the epidermis. Melanoma in situ has a Breslow’s depth of zero and a Clark’s level of I. These melanomas have a long term survival rate of nearly 100% when treated with appropriate surgery.

 

Melanomas with a Breslow’s depth of less than 1 mm are considered thin melanomas and have a favorable long term prognosis. The long term survival rate is about 90-95% with appropriate surgical treatment. For melanomas with a Breslow’s depth of greater than 1 mm, the long term survival rate gradually decreases with increasing depth of the melanoma.

 

For these thicker melanomas, the lymph nodes are sometimes surgically removed and checked under the microscope for the presence of melanoma. In these cases, whether or not cancer is detected in the lymph nodes becomes an important factor in predicting long term survival.


What treatments are available for melanoma?

 

Surgical removal is the main treatment for melanoma. The type of surgery recommended is determined by the depth of the melanoma. For melanomas with a Breslow’s depth of less than 1 mm, surgical removal of the melanoma and a zone of surrounding skin is all of the treatment that is needed.

 

This can usually be accomplished with an in-office surgery performed with local anesthesia. It is not usually necessary to see another surgeon or to go to a hospital operating room. For melanomas with a Breslow’s depth of greater than 1 mm, it may be beneficial to have lymph nodes surgically removed in addition to the removal of the melanoma. This surgery is usually performed in a hospital setting by a general surgeon or a cancer surgeon.

 

While surgery is the main treatment for melanoma and the treatment with the greatest chance of a cure, some patients with melanoma have chemotherapy in addition to surgery. Chemotherapy is usually reserved for patients whose melanoma has already spread to other parts of the body at the time of surgery or whose melanoma will likely spread in the future.

 

Several different chemotherapy regimens are available. No single regimen has been shown to dramatically prolong survival, but clinical trials are underway to discover better medical treatments for melanoma.


What is a sentinel lymph node biopsy?

 

A sentinel lymph node biopsy is a type of surgery sometimes recommended for patients with melanoma. The purpose of the surgery is to find out if melanoma has spread to the lymph nodes. A sentinel lymph node biopsy is usually performed in a hospital operating room and is done at the same time as the surgical removal of the melanoma.

 

Before the surgery, a radioactive dye is injected into the skin at the site of the melanoma. Then sensors are used to follow the path of the dye to the lymph nodes. This process identifies which lymph nodes are most likely to have melanoma if the melanoma has spread to the lymph nodes. Then the surgeon removes the melanoma and the lymph nodes identified by the dye. The lymph nodes are checked under the microscope for the presence of melanoma.

 

Sentinel lymph node biopsy is not usually recommended for melanomas with a Breslow’s depth of less than 1 mm. If the Breslow’s depth of the melanoma is greater than 1 mm a sentinel lymph node biopsy may be recommended.

 

Not all physicians agree about how important it is to have a sentinel lymph node biopsy performed. Sentinel lymph node biopsy has not been shown conclusively to increase the chances of curing melanoma, but it does provide valuable information for predicting how likely it is that the melanoma could result in death.


What do I need to do now that I have a melanoma?

 

The first thing that is needed is to have treatment for the melanoma. After the treatment for the melanoma is completed, you should see your dermatologist regularly for follow-up exams. Your dermatologist will examine the area where the melanoma was treated to make sure that it is not growing back and will also check your skin for new skin cancers. Once you have been diagnosed with melanoma, you are in the highest risk group for developing a new melanoma. You should have a full skin exam by a dermatologist two to four times a year for the first five years after the melanoma has been diagnosed and then at least once a year for the rest of your life.

You should examine your own skin thoroughly each month. Use a well lighted room and the combination of a full length mirror and a hand held mirror to check all of the areas that are hard to see. A spouse, parent, or friend can also help you. Notify your dermatologist of any new growths, any spots that are changing, and any spots that “look funny.” Most melanomas are discovered by a patient or spouse and then brought to the attention of the doctor. Carefully examining your own skin is the best defense against a future melanoma.

You need to let your primary care doctor know that you have had a melanoma. Some doctors may want to do chest x-rays or extra blood tests on their patients with a history of melanoma. You also need to let your doctor know if you develop any health changes such as unintentional weight loss, severe headache, weakness, and jaundice. Other health care providers who should be notified of your history of melanoma include your dentist, your ophthalmologist, and your gynecologist (for women).

You should notify all of your first degree relatives that you have had a melanoma. First degree relatives are your parents, siblings, and children. Melanoma tends to run in families. All of your first degree relatives should have a full skin exam by a dermatologist at least once a year.

It is also important to protect your skin from the sun. Regular sun protection can decrease your chances for developing future skin cancers. The following steps should be taken for sun protection:

  • Do not intentionally expose your skin to natural or artificial sunlight.

  • Avoid sun exposure when possible, especially in the middle part of the day when the sun is most directly overhead.

  • Protect your skin from the sun with clothing. Wear a hat with a broad brim, sunglasses, a long sleeved shirt, and pants when outdoors.

  • Apply sunscreen with an SPF of 15 or higher to all skin surfaces that you cannot cover with clothes.

The above steps for sun protection are listed in the order of importance. Used together these steps will reduce your chances of developing more skin cancers.


Where can I learn more about melanoma?

 

Your dermatologist can answer many of your questions about melanoma. Other good sources of information include: