Early detection is key for treating any cancer, especially melanoma where early detection and treatment lead to a very high curability rate. The American Cancer Society estimates more than 76,000 people in the U.S. will be diagnosed with Melanoma in 2014, numbers that continue to increase year over year.
Most melanoma is treated surgically, and in many cases this surgery is curative. Through numerous clinical trials, the surgery that is required to treat melanoma has become less invasive. A number of these less radical procedures were pioneered at our Melanoma Program.
Sentinel lymph node biopsy
One example is the sentinel lymph node biopsy. In the past, patients with intermediate-risk melanoma underwent complete removal of all regional lymph nodes, a procedure that has a moderate complication rate. The sentinel node biopsy, developed by our center’s Donald L. Morton, M.D., and evaluated in clinical trials, has been demonstrated to be more accurate and much less morbid than the old approach. The procedure is minimally invasive and is done on an outpatient basis. In some cases, the larger operation may still be needed, but four out of five patients can be spared. We are conducting more research to determine if we can reduce the need for this surgery further. If it is needed, we are exploring ways of performing the larger surgery in a minimally-invasive fashion.
Leading-edge treatments and therapies
Medical treatments for melanoma are rapidly evolving, and a great deal of progress has been made in recent years. Our physicians are at the forefront of many of these new therapies and can help patients sort through the complex and changing information about established treatments, such as interferon, and newer, recently developed drugs.
Early detection and diagnosis
If melanoma is detected early, nearly all patients can be treated easily and will likely be cured. Advances in early detection and diagnosis of melanoma are leading to earlier treatment and an increase in overall survival rates.
If you’ve been identified as being at a higher risk for a melanoma diagnosis because you have light skin and greater sensitivity to the sun, have multiple atypical nevi or moles, large congenital moles, a family history of melanoma, and a history of blistering sunburns, you may be a candidate for melanoma screening.
Melanoma is predominantly a disease of Caucasians, and is slightly more common in men than women. Primary lesions occur most commonly on the trunk in males, while most melanomas in females occur on the lower extremities.
Where melanoma begins
Cutaneous melanomas usually begin in cells known as the epidermal melanocyte. Early signs of melanoma include:
- Lesion asymmetry or border irregularity on moles
- Bleeding or crusting
- Recent changes in moles
- Variation of color on existing moles (though some are non-pigmented)
- Diameter over 7 millimeters
- Development of an elevated area (or palpable nodule)
Although several noninvasive diagnostic techniques for evaluation of skin lesions exist, biopsy is indicated for all suspicious pigmented lesions. Because tumor thickness is often what determines prognosis and treatment, the biopsy technique is critical. For most small and medium-sized lesions the ideal biopsy technique is complete full thickness excision of the lesion.
Accurate pathologic interpretation of the biopsy specimen is what helps determines treatment and prognosis.
Several characteristic of primary melanoma tumors help predict the prognosis and risk of metastases. Tumor thickness is the strongest predictive characteristic for recurrence in patients with primary cutaneous melanoma. Because thickness is so important, melanomas are commonly referred to as thin (generally less than 1.0 mm thick), intermediate (1.0 to 4.0 mm thick) and thick (greater than 4 mm thick).
Melanomas on the arms and legs generally have a better prognosis than those on the head and neck or trunk. Mucosal melanomas have an overall poor prognosis, often because they are detected late. Numerous studies have shown women fare somewhat better than men with melanoma, though the reasons for this are unclear.
Early melanomas (Stages 1 and 2) are localized, and more advanced melanomas (Stages 3 and 4) have spread (metastasized) to other parts of the body. There are also subdivisions within stages. The lower or earlier the stage the more likely it is that a patient will be cured of it. It is important to remember that there are many numbering systems within melanoma evaluation. These can be confusing, and it is often helpful to have a physician explain the meaning of all of the numbers. For example a Stage 3 melanoma is very different from a melanoma with Level III invasion.
In Stage 3 melanoma, cancer cells have spread from the primary tumor site through small channels in the tissue (“lymphatics”). These tumor cells can be detected as metastases in lymph nodes in the region of the primary melanoma, or as nodules of melanoma in the nearby skin (“in-transit metastases). If melanoma spreads this way, the risk of it spreading further in the body is greatly increased.
If the disease has advanced to Stage 4, the melanoma cells have traveled through the body via the bloodstream or lymph vessels and have settled into another area of the body, likely far from the original tumor site. These cells may have reached distant lymph nodes or invaded the internal organs. This can be in addition to or instead of the lymphatic spread.
Melanoma risk factors
Anything that increases your chance of getting melanoma is a risk factor. Sun damage, especially a history of peeling sunburns, is the main risk factor for melanoma. Artificial sunlight from tanning beds causes the same risk for melanoma as natural sunlight. Tanning in the sun or in tanning beds always involves radiation damage to the skin and increases the risk of skin cancer.
Other risk factors for melanoma include:
Fair complexion: People with blond or red hair, light skin, blue eyes and a tendency to sunburn are at increased risk.
- Previous melanoma
- A large number of benign (non-cancerous) moles
- Family history of melanoma
- Atypical mole and melanoma syndrome (AMS)
- If you have AMS, you and your family members should be screened regularly
Not everyone with risk factors gets melanoma.
Individuals are encouraged to visit with their primary care doctor or a dermatologist if there is any concern or suspicion about melanoma. Early detection is vital to treating and surviving cancer.