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Melanoma

Skin cancer can be divided into non-melanoma and melanoma types. Non-melanoma (basal cell and squamous cell skin cancer) is the more common form with over 3,000,000 cases diagnosed annually in the US. Most of these forms of cancer are curable. Melanoma, on the other hand, is a more serious skin cancer type. Although it affects approximately 5 percent of skin cancer cases, it causes over 75 percent of all skin cancer deaths. An estimated 76,690 new cases of invasive melanoma will be diagnosed in the US in 2013 and an estimated 9,480 people will die of melanoma in 2013.

Know How to Spot Melanoma with the ABCDE's

Melanoma usually presents as a pigmented (dark) mark on the skin. You can perform your own skin cancer self-exam with the signs that dermatologists look for, called the ABCDEs.

A) Asymmetry-One half unlike the other half.
B) Borders- Irregular, scalloped or poorly defined border.
C) Color- Varied from one area to another; shades of tan and brown, black; sometimes white, red or blue.
D) Diameter- While melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, they can be smaller.
E) Evolving- A mole or skin lesion that looks different from the rest or is changing in size, shape or color.

To diagnosis a melanoma, a dermatologist may perform either a shave biopsy, punch biopsy, or excisional biopsy. The type of biopsy depends on many factors, depending on the size, shape, location, and other factors.

If a diagnosis of melanoma is confirmed, the treatment protocol varies widely depending on many factors, including size, depth, ulceration, lymph node involvement, genetic testing, and mitotic index (cancer cell activity).

Treatment may include:

  • Excision- Cutting out the skin cancer with a scalpel. Surgical margins examined for clearance of tumor. Re-excision may be necessary if margins are not clear. (Time: 60-90 minutes)
  • Mohs Surgery- Cutting out the skin cancer under microscopic control. After removal of the skin cancer with small margins, the tissue is mapped out and cut in a way to be able to examine the deep and side margins. If the margins are clear, the wound can be closed. If the margins are not clear, a small amount of additional tissue is removed in only the involved area. This tissue is then inspected microscopically and if the margins are now clear, the wound can be closed. If not clear, the process is repeated until the margins are finally clear and the wound is finally closed. (Time: 2 hours- weeks, if specimens need to be processed in formalin instead of by frozen section)
  • Excision with sentinel node biopsy- Cutting out the skin cancer with a scalpel. Dye is injected at time of excision in the location of the excision, and the lymph nodes where the dye drains to are removed and examined of melanoma cells. Surgical margins examined for clearance of tumor. Re-excision may be necessary if margins are not clear. (Time: 60-180 minutes).
  • Chemotherapy- These medications attack the melanoma cells to kill them in the body. The drugs are usually injected into a vein or taken by mouth as a pill. They travel through the bloodstream to all parts of the body and attack cancer cells that have already spread beyond the skin. Because the drugs reach all areas of the body, this is called a systemic therapy.

Several chemotherapy drugs can be used to treat melanoma:

  • Dacarbazine (also called DTIC)
  • Temozolomide
  • Nab-paclitaxel
  • Paclitaxel
  • Carmustine (also known as BCNU)
  • Cisplatin
  • Carboplatin
  • Vinblastine
  • Immunotherapy- Immunotherapy is the use of medicines to stimulate a patient’s own immune system to recognize and destroy cancer cells more effectively. Several immunotherapy medications can be used to treat patients with advanced melanoma, either alone or in combination with chemotherapy medications.
  • Ipilimumab (Yervoy)
  • interferon-alpha
  • interleukin-2
  • Bacille Calmette-Guerin (BCG) vaccine
  • Imiquimod (Aldara, Zyclara)
  • Clinical Trial Medications- fortunately, research into melanoma treatments is very active. Many new treatments are being developed and clinical trials are available. Please visit http://www.cancer.gov/clinicaltrials or http://www.cancer.org/clinicaltrials for more details.
 
ADSCI - Advanced Dermatology Skin Cancer Institute Linage Dermatology Linage Skin Care