This fact sheet on Melanoma (Skin Cancer) has been written by Professor Anthony Dixon & the ACCO team - 2021 © ACCO.
What is Melanoma?
Melanoma is the most dangerous of the commoner skin cancers. Of every ten people that die of skin cancer, eight die of melanoma. It usually starts as a skin lesion. The cancer cells then get into the blood stream and can spread to any other part of the body. It is the spread elsewhere that can result in death.
What does it look like?
It is generally a dark coloured mole that has an irregular shape. Most lie flat within the skin rather than sticking out from the skin. Most cannot be felt. Other melanoma can appear as a bump in the skin. A melanoma that can be felt is more serious than one that can be seen but not felt. The most common site for a melanoma is on the arms, legs or back. They can grow on any skin site.
Where can Melanoma spread to in the body?
Melanoma can spread anywhere. The commonest site is lymph nodes. It can also spread to nearby skin sites. It is more serious when it spreads to places like the lungs, liver and brain. Spread to these distant sites has a concerning risk of death.
What is the usual treatment?
Skin melanoma lesions are invariably excised. Usually, the doctor takes out just the lesion to confirm the diagnosis. When confirmed a larger excision is organized. This second excision requires a ring of non-involved skin being removed from around the melanoma. The clearance is usually 1 or 2 cm of apparently normal skin.
Early diagnosis and treatment of a melanoma is the key to maximizing survival. Try to catch the melanoma before it has spread.
Will Melanoma come back?
With excision of a suitable margin of normal skin around the melanoma, recurrence is minimized. The chances of your melanoma returning are dependent on individual factors of your condition. These features include: the thickness the cancer penetrates the skin, its body location, whether the cancer had an ulcer on its surface, whether there are lymph nodes involved and whether it is spread to other places in the body. This involves a detailed one-on-one discussion with your doctor. ACCO has another fact sheet dedicated just for this aspect of melanoma.
What about sentinel lymph node biopsy?
SLNB is an operation when a lymph node is removed. It is commonly done at the same time as the large excision. While once popular, research has shown this operation does not improve survival. It does give some added information on chances of survival – but not much. Specialized dedicated ultrasound can provide similar added information. As such, SLNB is not a routine part of managing melanoma. Talk to your doctor.
What happens if Melanoma spreads in my body?
While usually fatal in the past, there are now treatments for when melanoma spreads through the body. Several drug therapies are now available. If you have skin cancer spread, you will likely be referred to a medical oncologist, - a specialist in these cancer drug therapies.
What about further surgery or radiation?
Sometimes surgery also plays a role in melanoma spread. If the skin cancer has spread to a single site, surgery can be helpful. But drug therapy is more important. Radiation is not commonly used managing melanoma. Radiation can be handy when a site of spread produces marked local pain.
Will I get more of them?
Any person who has developed a melanoma is especially prone to further skin cancers. Not only are further melanomas possible, but other skin cancers can occur on any part of the skin. Ongoing skin checks are essential. Talk to your doctor about Vitamin B3 supplements. ACCO has a fact sheet on the place of added Vitamin B3.
How do I prevent them?
Reducing sun exposure helps:
- Suntan or sunburn means future skin cancer risk.
- Avoid outdoors 11:30 AM to 3:00 PM.
- Apply and re-apply sunscreen regularly.
- Shade over pool & playgrounds protects our kids.
- Long-sleeved shirts.
- Hats with a brim.
- Drive with windows up.
- Sunglasses.
- Long pants or skirts.
- 50+ Sunscreen.
- Umbrellas and shelters.
- Enclosed tractors.
What follow-up do I need?
Check your own skin each month. There are parts of your skin you cannot see. Ask your partner or friend to check these areas for you. See your doctor if any new or changing skin lesion develops. Your doctor has seen many of these skin lesions and will know what management is required. Patients who have had skin cancer need at least 6-monthly skin checks by a doctor for life. Initially checks will be even more frequent. Talk to your doctor about the best regular skin checkup plan for you and your skin. At checkup, your doctor will do more than a skin check. They will ask about your wider health.