Melanoma, also called malignant melanoma, arises in the pigment producing cells of the skin called melanocytes. It is much less common than basal cell or squamous cell carcinoma, but it can also be much more serious. When caught early, it can be easily cured with surgery.
Why is Melanoma So Dangerous?
The longer melanoma is present, the more likely it is to metastasize, or spread, to other parts of the body including adjacent lymph nodes or even more distant areas.
Melanoma usually appears as an irregularly shaped mole on the skin and can appear anywhere, not just on sun exposed areas. Since it arises from melanocytes it is usually composed of shades of black or brown, but may also contain shades of red and blue.
What are the Different Types of Melanoma?
There are several subtypes of melanoma. These include melanoma-in-situ, which is confined to the very top layer of skin and is almost always curable by surgically removing it, as well as superficial spreading, nodular, lentigo maligna, and acral lentiginous melanomas.
The thickness of a melanoma (how deep it extends under the skin) is very important, as this affects the prognosis and treatment. The thickness is measured in millimeters. The thicker the melanoma, the more likely it is to have spread to other parts of the body.
A thin melanoma is less than or equal to 0.8mm, and these melanomas are almost always treated exclusively with surgery under local anesthesia in our offices. This surgery may be either a standard excision, or Mohs surgery.
An intermediate melanoma is 0.8 mm to 4 mm thick and is typically treated with surgery in addition to a ‘sentinel lymph node biopsy’. A sentinel lymph node biopsy is performed by a surgical oncologist, and he or she will inject a dye into the area of the cancer to see which lymph nodes the tumor drains to. These lymph nodes are then sampled to make sure that the melanoma has not spread to the lymph nodes. Sometimes patients with intermediate melanomas receive systemic treatment in addition to surgery and sentinel lymph node biopsies.
Thick melanomas are greater than 4 mm, and imaging studies are almost always done to ensure that the melanoma has not spread to other parts of the body. Treatment of these thicker melanomas often involves systemic therapies through medical oncologists, in addition to surgery.
What are Melanoma Treatment Options?
Not too long ago, there were limited effective treatments for aggressive melanomas or melanomas that had metastasized to other parts of the body and the prognosis was very poor. However, in the last few years a new type of treatment called immunotherapy has vastly improved our ability to treat and even cure more aggressive melanoma.
The immunotherapy medications are intravenous infusions that stimulate the body’s own immune system to attack the cancer cells. There are several immunotherapies approved for melanoma including pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), and ipilimumab (Yervoy).
In addition to these immunotherapies, there are other targeted systemic agents that are used to treat aggressive melanoma including BRAF inhibitors (vemurafenib, dabrafenib, and encorafenib) and MEK inhibitors (trametinib, cobimetinib, and binimetinib).
If you do have a deeper melanoma that requires a sentinel lymph node biopsy or systemic treatment, we will refer you to a center specializing in the treatment of melanoma where a comprehensive evaluation and more advanced treatments can be provided. As always, even if we refer you to a specialty center, we will be available to answer any questions that may arise and to guide you throughout the process.
If you or a first-degree relative have had a melanoma, you should be screened regularly with a full body skin examination by a dermatologist to monitor for a recurrent or new melanoma. After a melanoma diagnosis, these skin examinations are typically done every 3-6 months for several years and then may be spaced out. You should also perform self-exams to look for suspicious growths on your skin, and let us know if you have noticed any new lesions in between your scheduled skin examinations.
How to Perform a Self-Skin Examination for Melanoma Detection
Catching melanoma early can make a big difference in treatment success. Here’s how you can perform a self-skin examination:
- Check Your Entire Body: Use a full-length mirror to examine all areas of your body, from the front, back, and both sides. Don’t forget less visible spots like your scalp, back, buttocks, and genital area.
- Use a Hand Mirror:Â For hard-to-see areas, use a hand mirror. Check your scalp and between your buttocks.
- Inspect All Moles and Spots:Â Look for new moles or changes in the existing ones. Follow the ABCDE rule, which stands for asymmetry, border, color, diameter, and evolving.
- Document Changes:Â Keep a record of your moles and their appearance. Take photos if possible, to track any changes over time.
- Schedule Regular Check-Ups:Â If you notice any changes, schedule an appointment with one of our dermatologists immediately.
Preventive Measures to Reduce the Risk of Melanoma
Reducing your risk of melanoma is possible with these preventive measures:
- Limit Sun Exposure:Â Avoid the sun between 10 a.m. and 4 p.m. when UV rays are strongest.
- Wear Sunscreen:Â Apply broad-spectrum sunscreen with at least SPF 30, even on cloudy days.
- Cover Up:Â Wear hats, sunglasses, and protective clothing when outdoors.
- Avoid Tanning Beds:Â Tanning beds increase the risk of melanoma significantly. Opt for self-tanning products instead.
- Regular Dermatologist Visits:Â Regular check-ups can catch melanoma in the earliest and most treatable stage.
Melanoma Treatment FAQs
How is Mohs Surgery Different from Standard Excision for Melanoma?
Mohs surgery and standard excision are both effective treatments for melanoma, but they are used in different scenarios based on the cancer's characteristics.
- Mohs Surgery: This procedure is highly precise. It involves removing the skin cancer layer by layer and examining each layer under a microscope until no cancer cells are detected. This method is ideal for areas where preserving as much healthy tissue as possible is important, like on the face.
- Standard Excision: In this method, the melanoma and a margin of surrounding healthy skin are removed all at once. It’s typically used for melanomas that are thicker or located in less visible areas of the body where cosmetic results are less of a concern.
Each technique has its advantages, and your dermatologist will recommend the best approach based on your specific case.
Can Melanoma Spread Even If It Hasn't Been Exposed to Sunlight?
Yes, melanoma can spread even from parts of your body that haven't been exposed to sunlight. While UV radiation is a significant risk factor for melanoma, this type of cancer can develop in areas that are rarely exposed to the sun, such as the soles of the feet, palms, and under the nails. Genetic factors and skin type also play a role in melanoma development. Regular self-examinations and dermatologist visits are crucial for early detection and treatment.
Is There Long-Term Follow-Up Care After Melanoma Treatment?
Yes, long-term follow-up care is crucial after melanoma treatment. This ongoing care helps ensure that the melanoma has not returned and helps to catch any new melanomas as early as possible. Here's what follow-up care typically involves:
- Regular Skin Exams: These exams, conducted by you and your doctor, are critical for spotting new melanomas or changes in existing moles.
- Scheduled Visits: Depending on the stage of the melanoma and treatment outcomes, you might see your dermatologist every few months initially and then once a year.
- Health Maintenance: Follow-up care also includes maintaining a healthy lifestyle and protecting your skin from sun exposure to reduce the risk of new melanomas.
Contact Us For An Appointment
If you have melanoma or are simply seeking a skin exam to look for skin cancer, please call us today at (818) 842-8000 or contact us online for an appointment.
