Melanoma (Skin Cancer)

July 5, 2019 Written by Beautiphi - 0 Comments

Melanoma (Skin Cancer)

Melanoma is cancer of pigmented cells in the skin.  It is one of the most common skin cancers diagnosed in New Zealand and it is also the most serious.  The number of people diagnosed with melanoma has been increasing every year.

About 85 people out of every 100 diagnosed with melanoma will survive if it is detected and removed at an early stage.  However, a melanoma that is not treated early enough can spread to other parts of the body and become life-threatening.

Men and women are equally at risk.  Men are more likely to develop a melanoma on the face, back, and chest.  In women, the arms and legs are the most common sites.  Melanoma can occur at any age, but rarely in childhood.

The Cause of Melanoma

Melanocytes are skin cells that produce a pigment called melanin when exposed to the sun.  They lie at the junction between the upper (epidermis) and the lower (dermis) layers of the skin.  Suntans and moles are due to melanin.  If the melanocytes multiply uncontrolled, a melanoma will develop.  The pigment melanin does not itself cause a melanoma.

Although doctors do not fully understand why melanomas occur, they do know that exposure to the sun, especially in fair-skinned people exposed from a young age, increases the risk.

About half of all melanomas begin in a mole that has been present for some years.  The changes in melanocytes that lead to a melanoma take time and can usually be detected early if regular medical examinations of the skin are performed. Although exposure to the sun’s ultraviolet radiation increases the risk of developing melanoma, cancer does not necessarily form on the skin that has been directly exposed to the sun.

Differences between Benign Moles and Melanomas

Benign (non-cancerous) moles tend to have asymmetrical, round, or oval shape.  They may be flat or raised, and the color is usually a uniform shade of tan, brown, or black.  Adults usually have up to 50 normal moles, but some people may have hundreds.  A medical examination is needed if a mole shows any change, such as:

  • a change in color
  • development of an irregular shape and a tendency to spread along the skin
  • an increase in size

A melanoma arising from normally pigmented skin may have irregular shades of brown or black or have multi-colored patches of blue, red, or white.  Some melanomas contain very little melanin and are called ‘amelanotic’ melanomas.

Melanoma Stage Description Treatment Option
0 The tumor is confined to the epidermis and has not entered the dermis, a deeper layer of the skin. This stage of melanoma is also called melanoma in situ. The tumor and some surrounding tissue are removed surgically. Usually no further treatment is necessary; however, continued skin examinations to evaluate for a new melanoma or other skin cancer will continue.
IA The tumor is less than 1 millimeter thick. The outer layer of skin does not look cracked or scraped (ulcerated). It has not spread to any lymph nodes or other organs. The tumor and some surrounding tissue are removed surgically. Usually, no further treatment is necessary.
IB The tumor is either less than 1mm thick and ulcerated, or 1–2 millimeters thick and not ulcerated. It has not spread to any lymph nodes or other organs. The tumor and some surrounding tissue are removed surgically. Usually, no further treatment is necessary.
IIA The tumor is either 1–2 millimeters thick and ulcerated, or 2–4 millimeters thick and not ulcerated. It has not spread to any lymph nodes or other organs. The tumor and some surrounding tissue are removed surgically. Usually, no further treatment is necessary.
IIB The tumor is either 2–4 millimeters thick and ulcerated, or more than 4 millimeters thick and not ulcerated. It has not spread to any lymph nodes or other organs. The tumor and some surrounding tissue are removed surgically. Additional treatment(s) may be recommended.
IIC The tumor is more than 4 millimeters thick and is ulcerated. These are aggressive tumors that are more likely to spread. The tumor and some surrounding tissue are removed surgically. Additional treatment(s) may be recommended.
IIIA

IIIB

IIIC

The tumor may be of any thickness. It may or may not be ulcerated. The cancer cells have spread either to a few nearby lymph nodes or to some tissue just outside the tumor but not to the lymph nodes. The tumor and lymph nodes that have cancer cells are removed surgically. Additional treatment(s) may be recommended.
IV The cancer cells have spread to the lymph nodes, other organs in the body, or areas far from the original site of the tumor. This is called metastatic melanoma. The tumor and lymph nodes that have cancer cells are removed surgically. Additional treatment(s), like immunotherapy and targeted therapy, may be recommended.

 

Risks

All surgical procedures have risks.  While surgeons make every attempt to minimise risks, complications can occur which may have permanent effects.  When you are making the decision to have surgery, you must keep in mind that your surgeon cannot guarantee that the surgery will always be successful or that the surgery bears no risk.  The operation and its outcome might not fully meet your expectations.

It is not usual for a doctor to dwell at length on every possible side effect or rare, serious complications.  Sometimes such detail can frighten the patient so much that treatment is refused and the patient is worse off than running the usually small risk of complications.

Some of the risks of melanoma surgery do include the following:

  • Wound infection – not common, but if it occurs, treatment with antibiotics may be necessary.
  • Bleeding from the wound.
  • Bruising and swelling – usually settles down in the week after surgery. To help reduce swelling, keep the affected area raised.  For example, rest your feet on a chair if the wound is on a lower limb.
  • Scarring of the surgical site – depends on factors such as the size of the melanoma, its position on your body, the rate at which the wound heals, and your genetic make-up. Some people develop thick, raised, and itchy keloid scars.  A keloid can be annoying but is not a threat to health.
  • Scarring around the margins of graft is normal. Despite the high skills of your surgeon, this can sometimes be disfiguring.  Some areas of the body scar more than others.  If a large area of skin has to be removed, it is not possible to avoid scarring.
  • Multiple scars may occur when many moles are removed. This can be disfiguring, regardless of their position on the body.
  • Swelling of the leg commonly occurs if the lymph nodes in the groin nearest the melanoma are removed. Swelling of an arm is uncommon after removal of lymph nodes in the armpit.  Stiffness on the joint or muscles around the area is common.
  • Wound Breakdown: Although wounds usually heal well in two weeks or so, they are not fully healed for several weeks. Once the stitches have been removed, any strenuous activity or unexpected pulling movements may cause the wound to reopen.  This can usually be avoided by treating the area with care for several weeks.
  • Psychological Factors: The diagnosis of cancer can be an extremely stressful event. Some people become depressed, moody, or anxious as a result, even if a cure is the most likely outcome.  This is not uncommon.  Understanding the illness, its progress and treatment, are important ways of reducing stress.  Personal counseling or referral to a local support group or anti-cancer council can be beneficial in discussing any fears or concerns.

You can also have non-surgical treatments – chemotherapy, radiotherapy or vaccine therapy.  Dr Taylor will be able to discuss other options with you if these are necessary.

To Prepare for your surgery

When answering questions about your medical history and current medications, be both honest and thorough. The success of your surgery hinges on making sure your doctor knows all of the facts about your health, including the use of tobacco, alcohol, over-the-counter medications, and herbal supplements.

Tobacco, in particular, can hinder your healing process and may have adverse effects on your results.

Do not drink alcohol prior to surgery for at least 3 days – 2 weeks.

Do not take aspirin, unless discussed with your doctor in advance for urgent medical reasons.

Do not take any other anti-inflammatories for two weeks before surgery.

Notify us about any other drugs or natural remedies you are taking.

Fish, fish oil, spicy food, and green tea are also known to increase your bleeding by thinning your blood and adding to bruising and bleeding complications during and after surgery.

Do not take arnica, as this also can increase bruising.

 What you can expect during the procedure

Diagnosis 

If there is a suspicion that a spot on the skin is melanoma, it must be biopsied to obtain a definite diagnosis. In this procedure, the goal is to remove all of the suspicious-looking growth. If this is not possible due to the tumor’s size or other limitations, then a sample of the tissue is removed. Several biopsy techniques are described below.

Excisional Biopsy

This type of biopsy attempts to remove the growth in its entirety. In general, this is the best approach because it allows the pathologist who reviews the tissue to examine the entire growth. Depending on the size and the location of the growth, an excisional biopsy can be performed using a number of different techniques, including:

  • Elliptical excision – the growth is removed by cutting around it with a scalpel and sewing the skin together.
  • Punch biopsy – a cylindrical instrument (called a punch) is used to remove the mole and a small area of normal skin around it.
  • Shave biopsy – a scalpel alone is used to get underneath the growth.

Elliptical and Punch biopsies require sutures, whereas Shave biopsies do not. However, Shave biopsies may not always remove the entire growth, so they should be performed by experienced healthcare professionals when melanoma is suspected.

Incisional Biopsy

This type of biopsy attempts to remove a piece of the growth. This is usually not the preferred approach but sometimes has to be used if the suspected melanoma is unusually large, in a sensitive location (such as the face), or in which complete removal would require drastic surgery.

For incisional biopsies, the same three approaches described for excisional biopsies would typically be used.

Once the biopsy is performed, it is sent to a pathology laboratory for review by a pathologist, who makes the final diagnosis. For a suspected eye melanoma, the diagnosis is made on clinical examination of the growth in the eye by an experienced ophthalmologist, and a biopsy is not usually performed. When melanoma appears in unusual locations, such as the lymph nodes or internal organs, a partial biopsy of the involved area or complete removal of the growth is performed to make the diagnosis.

After the procedure

Depending on the type of surgery performed, you may be able to go home shortly afterward, or you may have to stay overnight, or for a few days.  Some surgery will be minor and only mildly uncomfortable.

If a large melanoma has been removed or a skin graft performed, there may be discomfort or pain.  The area where the skin is removed for the skin graft is often more uncomfortable than the grafted area.  Pain relief may be required for two or three days.  Paracetamol (available from your local pharmacy)  will usually be sufficient, but stronger pain relief may be needed. Aspirin should not be taken for two weeks after surgery as it may increase bleeding.  Do not drive if you are taking a prescription painkiller or sedative.

The incision should heal in seven to ten days.  The stitches will then be removed and replaced with a dressing.

Skin grafts usually take about two to three weeks to heal.  You should be careful to avoid any strenuous activity for at least three weeks, or possibly longer, after the surgery.  Your doctor will instruct you on when you can shower and return to normal activities and work.

After arriving home, contact your doctor if any of the following occur:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Pain that you can’t control with the medications you’ve been given
  • A new lump or discoloration in your skin
  • A change such as color, bleeding, itching, or growth in an already-existing mole, either at the surgical site or in a new location.
  • Any other new or concerning symptoms

Results

Even if you have completed treatment, your doctor will still want to watch you closely. It’s very important to keep all follow-up appointments. Follow-up is needed to check for signs of cancer coming back, as well as possible side-effects of certain treatments. This is also a good time for you to ask your doctor any questions you need to be answered and to discuss any concerns you have.

We have 2 experts in Melanoma detection and removal – Dr. Brent Krivan at Clinic Eleven and Dr. Greg Taylor (plastic surgeon).

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