Melanoma is cancer that develops in the cells that give color to the skin called melanocytes. Melanocytes are the pigmented cells which produce melanin to protect the skin from ultraviolet radiation produced from sunlight. There are many types of skin cancers/Melanomas. These melanomas may start in any area of the skin.
A change in the appearance of a mole signifies the chances of melanoma. Similarly, pigmented areas on the skin may show change in their looks which again may be a sign of melanoma. A mole is aggregation of some of the melanocyte cells in the skin. These are usually quite safe but sometimes they begin to grow in abnormal and uncontrolled way deeper into the layers of the skin causing melanoma or skin cancer.
This cancer is the most dangerous form which grows rapidly, reaches the lymphatic system and spreads to other parts of the body. The accurate cause of all melanomas is not clearly understood but exposure to tanning lamps and ultraviolet radiation from sunlight raises your risk of developing melanoma especially in young women under 30. Major factors that contribute to skin melanoma are:
- Fair skin which burns easily
- Exposure to natural sunlight or tanning beds for longer periods of time
- Exposure to environmental pollutants such as radiation and toxic chemicals
- Having several moles or larger moles
- Having a family history or recurrence after the treatment
- Change in genes linked to melanoma
- Weak immune system
Advantages of the Surgery
There are several advantages to surgically removing a skin cancer, including:
- The cancerous lesion is totally removed and cannot spread other parts
- After the surgery, the sample can be carefully examined to determine how advanced the cancer
- The site if lesion will heal very fast
- It cures early stage melanoma completely
How to diagnose Melanoma
Melanoma diagnosis was made by self-examination of skin at home or by trained professional usually a dermatologist. However, the accurate diagnosis will be done with a skin biopsy. Doctors usually remove the entire moles for biopsy and in some cases, a part can be removed if it is very large. The thickness of the mole often determines the treatment plan if it is thicker the disease will be more severe.
To determine the spread of melanoma to nearby lymph nodes a sentinel node biopsy will be advised. If the lymph nodes are cancer-free there are high chances of recovery. Melanoma is classified into four stages which depend on the location either locally or it has spread to other organs the lower the number higher will be the survival rate.
Treatment options for Melanoma
Early stage melanomas will be effectively cured by surgery, if it has spread beyond the skin chemotherapy will be given where the drugs target directly to the site and radiation to remove the lymph nodes will be advised. Along with these biological therapies also given to boost the immune system for a speed recovery.
The following tests might be needed before the procedures and in the staging process:
- Physical exam and history: A whole body examination to check the symptoms of health, which also includes signs of disease like lumps that seems unusual. A history of the patient’s health and past illnesses and treatments will also need to be considered.
- Lymph node mapping: This test involves a radioactive substance or a blue colored dye to inject near a tumor. The substance or dye passes through lymph ducts to the sentinel node(s). The surgeon may excise the nodes having the radioactive substance or dye. The pathologist then reviews sample of tissue under a microscope to check for cancer cells and will issue the report. If there the cancer cells are observed, a surgery may be needed to remove more nodes.
- CT scan: This test is also called computed tomography, or computerized axial tomography. Pictures will be captured of the chest, abdomen, and pelvis region. The series of detailed pictures of these regions are provided by a computer connected to an X-ray machine.
- Positron emission tomography (PET) scan: This test is used to find malignant tumour in the body. In this test, a small amount of radioactive glucose will be injected into a vein and pictures will be captured where ever the glucose is being used in the body. In the pictures, the malignant tumor cells show brighter and active with more glucose uptake than the normal cells.
- Magnetic resonance imaging (MRI) with gadolinium: This test uses magnetic waves, and a computer to capture a series of detailed pictures of affected areas in the body. Like other tests in this, a different substance called gadolinium will be injected into a vein. The gadolinium will be located mostly around the cancer cells and show up brighter in the picture. This test is also called nuclear magnetic resonance imaging (NMRI).
- Blood test: This test needs a blood sample to check and to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for lactate dehydrogenase (LDH) enzyme. If LDH levels are higher than normal then may be a sign of melanoma.
The standard or first-line therapy for most of the melanomas is excision of a tumor. Normally minute size tumors having a size around half an inch are excised as an outpatient surgery.
- Most minor surgical procedures will allow for a primary closure of wounds and rarely, a skin graft with complex reconstruction is required to close the wound. In other cases, the melanoma which spreads to the lymph nodes may also need to be surgically removed.
- During the surgical procedure, the surgeon will excise a tumor along with the area of surrounding skin to minimize the risk of recurrence. The following criteria for the margin of tissue removed during surgery are classified based on their size and specific stages of the melanoma.
- Before the excision, the patient may receive a local anesthesia to numb the affected area. The excision can be done with the use of a scalpel or sharp razor, cutting and shaving a growth off the skin.
- In stage 0, an in situ melanoma where a tumor is restricted to the outer layer of skin, the surgeon will excise a tumor along with a ½ cm border of normal skin.
- For stage 1 melanomas with 1-2 mm thick, the surgeon will excise the tumor with a wide excision of 1 cm border of normal surrounding skin tissue.
- For stage 2 melanomas in which the tumor is between 1-2 mm thick having ulceration, or if the tumor is > 2 mm, the surgeon will excise the tumor with a wide excision of 2 cm border.
- For larger melanomas > 4 mm, the surgeon will remove the lesion along with a minimum 2 cm border of skin, unless the tumor is on the face, where a 2 cm margin could result in cosmetic flaws which are located very close to the eye or ear, nose or mouth.
After the removal of the cancerous lymph nodes in an area, the body’s ability to drain may be affected. This might lead to fluid collection at site of surgery. Moreover, the groin area will be difficult to keep clean and dry for good health. The patient needs to follow the directions below to reduce any side effects of the surgery and to promote wound healing.
- The patient may need to take care and not disturb the dressing.
- Need to be taken not to get your skin graft dressing wet.
- Need to sponge bath until the practitioner gives you permission to shower.
- If the surgery site is on your arm or leg, need to keep the arm or leg elevated above the level of your heart for most of the day and night.
- Swelling of the arm or leg should be taken care of as it will affect graft healing.
- If the surgery site is on the leg, will be given a prescription for a walker at your preoperative history and physical. The patient will not be able to put any weight on your leg for up to 2 weeks
- The patient may need to follow the instructions given at the postoperative visit as to when to increase the activity