Skin Cancer

Melanoma Basics

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

The prognosis for melanoma depends on the stage of the skin cancer at the time of diagnosis, which is based on specific features of the lesion and whether or not there is any evidence of melanoma elsewhere in the body.

The most important factor associated with survival in patients with melanoma is the thickness of the lesion. Thickness is most commonly reported as a measurement of depth given in millimeters, known as Breslow’s depth. Sometimes the thickness is reported in a different way—called the Clark’s level—which is 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, which means that the skin cancer is limited to the uppermost portion of the skin, dubbed the epidermis. Melanoma in situ has a long-term survival rate of nearly 100% when treated with appropriate skin cancer surgery.

Melanomas with a Breslow’s depth of less than 1 mm are considered thin melanomas and have a favorable long-term survival rate with appropriate surgical treatment. For melanomas with a Breslow’s depth of greater than 1 mm, the long-term survival rate decreases as the depth increases.

For these thicker skin cancers, the lymph nodes are sometimes surgically removed and checked under a microscope for the presence of cancer cells. In these cases, whether or not cancer is detected in the lymph nodes becomes an important factor in predicting longterm survival.

What Treatments Are Available for Melanoma?

Surgical removal is the main treatment for melanoma. The type of skin cancer 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 with a margin of normal skin is needed.

This can usually be accomplished with an in-office skin cancer 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 skin cancer. 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 skin cancer treatment with the greatest chance of a cure, some patients with melanoma have chemotherapy in addition to surgery. Chemotherapy is usually reserved for skin cancer 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.

What Is a Sentinel Node Biopsy?

A sentinel lymph node biopsy is a type of surgery sometimes recommended for skin cancer 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 skin cancer. 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 skin cancer has spread there. Then your surgeon removes the melanoma and the lymph nodes identified by the dye. The lymph nodes are checked under the microscope for the presence of skin cancer cells.

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 skin cancer lesion is greater than 1 mm, a sentinel lymph node biopsy may be recommended.

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

What Should I Do After a Skin Cancer
Diagnosis?

The first thing needed is to get treatment for the skin cancer. After this is completed, you should schedule regular follow-up exams with your dermatologist, who will examine the area where the skin cancer was treated to make sure it is not growing back and who will also check your skin for new skin cancers.

You should also examine your own skin thoroughly each month. Use a well-lighted room and the combination of a full-length mirror and a handheld mirror to check all of the areas that are hard to see. A spouse, parent, or friend can also help you. Notify us of any new growths, any spots that are changing, and any spots that “look funny.” Also pay attention to any spot that bleeds for no good reason or gets a scab that won’t heal. Most skin cancers are discovered by a patient or spouse and then brought to the attention of a doctor. Carefully examining your own skin is the best defense against a future skin cancer.

Once you have been diagnosed with BCC or SCC, you have a 50 percent chance of having another skin cancer within the next five years. 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.

If you have had melanoma, you need to let your primary care doctor know. 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.

You should notify all of your first-degree relatives—your parents, siblings, and children—that you have had a melanoma, as this skin cancer 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.