• Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin).
• Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma.
• Signs of melanoma include a change in the way a mole or pigmented area looks.
• Certain factors affect prognosis (chance of recovery) and treatment options.
• Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.
Signs of melanoma include a change in the way a mole or pigmented area looks, specifically a mole that:
Certain factors affect prognosis (chance of recovery) and treatment options:
After melanoma has been diagnosed, various tests may be done to find out if cancer cells have spread within the skin or to other parts of the body. These may include:
The staging of melanoma depends on the following:
The following stages are used for melanoma:
Stage 0 melanoma in situ. Abnormal melanocytes are in the epidermis (outer layer of the skin).
Stage I melanoma.
Stage II melanoma.
Stage III melanoma.
Stage IV melanoma.
Surgery for melanoma may include:
Possible complications of melanoma excision and sentinel lymph node biopsy surgery include but are not limited to the following:
Infection, bleeding, swelling, scarring, numbness, skin discoloration, poor wound healing, displeasure with the cosmetic outcome, need for additional procedures, nerve weakness, failure to identify the sentinel lymph node, false negative biopsy (<5% chance the cancer has spread but the sentinel node biopsy does not identify it), and allergic or other negative reactions to one or more of the medications or substances used in the operation.
In addition to helping doctors stage cancers and estimate the risk that tumor cells have developed the ability to spread to other parts of the body, surgical excision and sentinel lymph node biopsy (SLNB) may help some patients avoid more extensive lymph node surgery. Removing additional nearby lymph nodes to look for cancer cells may not be necessary if the sentinel node is negative for cancer. All lymph node surgery can have adverse effects, and some of these effects may be reduced or avoided if fewer lymph nodes are removed.
Researchers have investigated whether patients with melanoma whose sentinel lymph node is negative for cancer and who have no clinical signs of other lymph node involvement can also be spared more extensive lymph node surgery at the time of primary tumor removal. A meta-analysis of 71 studies that involved data from 25,240 patients suggests that the answer to this question is “yes.” This meta-analysis found that the risk of regional lymph node recurrence in patients with a negative SLNB was 5 percent or less (4).
Another question posed by researchers is whether SLNB plus the removal of the remaining regional lymph nodes (called completion lymph node dissection, or CLND) if the sentinel lymph node is positive for cancer has a therapeutic benefit for melanoma patients in terms of disease-free survival and melanoma-specific survival (length of time until death from melanoma). To address this question, NCI, the National Institutes of Health, and the John Wayne Cancer Institute conducting a large phase III clinical trial called the Multicenter Selective Lymphadenectomy Trial II, or MSLT-II. In this trial, more than 1,900 patients with positive sentinel lymph nodes but no clinical evidence of other lymph node involvement were randomly assigned to immediate CLND or regular ultrasound examination of the remaining regional lymph nodes and CLND if signs of additional lymph node metastasis appear. The patients in this trial were followed for 10 years, and the results showed no survival benefit to those patients who underwent an immediate CLND. For those patients with obvious clinical disease in the lymph nodes, a completion lymphadenectomy does have therapeutic benefit.
Surgery to remove the tumor is the primary treatment of all stages of melanoma. A wide local excision with 1-2 cm margins around the primary lesion is the method used to remove the melanoma and some of the normal tissue around it to ensure the entire malignancy is excised. Skin grafting (taking skin from another part of the body to replace the skin that is removed) or rearrangement of adjacent tissues may be done to cover the wound caused by surgery.
In melanomas with any potentially aggressive characteristics (depth > 1 mm, ulcerations, invasion of nerves or blood vessels, location in the head & neck), lymph node mapping and sentinel lymph node biopsy (SLNB) may be recommended to check for cancer in the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. The sentinel node is then checked for the presence of cancer cells by a pathologist. If cancer is found, the surgeon may remove additional lymph nodes, either during the same biopsy procedure or during a follow-up surgical procedure. SLNB is usually done at the same time the primary tumor is removed. However, the procedure can also be done either before or after removal of the tumor.
Arrange for someone to stay with you for the first 24 hours.
Go to bed and rest, lying on your back, with your head elevated with 2-3 pillows. You should be lying at a 45 degree angle.
You may be up and around and able to go to the bathroom. You will be able to eat a light meal with assistance.
Take medication only as directed.
Some swelling and bruising are a normal occurrence.
Place ice packs to the surgical site for the first 48 hours (on for 20 minutes, then off for 20 minutes).
Keep the incisions moist with petroleum-based ointment. Cover any draining area with bandages. If they loosen, secure them with more tape. You may have a drain in place, which will be removed with the first dressing change.
You may be up and around as tolerated but expect to tire more quickly than usual.
Keep activity and meals light, avoiding meals that require significant chewing.
On the 3rd day, you can remove all bandages and gently shampoo your hair in the shower with baby shampoo. It is advised to let your hair air-dry, but you may use a cool setting if you need to use a hair dryer.
You will come into the office for a post-operative check-up.
No alcohol for the first 7 days after surgery, which can increase bruising and swelling.
Your swelling and bruising will gradually fade over this time period, but it may persist for up to 3 weeks.
1. Rest and good nutrition are important healing factors, especially during the first 6 weeks.
2. Numbness, tingling, hardness, tightness, and bumpiness of the surgical area are common occurrences. If any of these things do occur, they will gradually subside over several months.