Surgical oncology

Melanoma

What is melanoma?

Melanomas are skin cancers. Most of these tumours are pigmented, which means that they are darker in colour than the surrounding skin. Melanoma originates in the cells (melanocytes) that create melanin, which gives your skin its colour. It is the most dangerous type of skin cancer. Melanoma can also develop in the eyes and, in rare cases, inside the body, such as the nose or throat.

Although the specific cause of all melanomas is unknown, ultraviolet (UV) radiation from the sun, tanning lights and beds increase your risk of acquiring melanoma. Melanoma risk can be reduced by limiting your exposure to UV light.

When is a mole suspicious?

Consider the letters ABCDE to help you recognise characteristics of odd moles that could signify melanomas or other skin cancers:

  • The letter A stands for asymmetrical shape. Look for moles with unusual conditions, such as two sides that look entirely different.
  • The letter B stands for irregular border. Melanomas have uneven, notched, or scalloped edges, which can be identified by looking for moles with these features.
  • The letter C represents colour changes. Look for growths with a variety of hues or an uneven colour distribution.
  • The letter D stands for diameter. A pigmented lesion or mole larger than 0.6cm is suspicious. A pigmented lesion or mole smaller than 0.6 cm but rapidly increasing in size should also be regarded as suspicious of a melanoma. Mole mapping with your dermatologist is advised.
  • The letter E stands for evolving. Examine for changes over time, such as a growing mole or changed colour or shape. Moles might sometimes acquire new signs and symptoms over time, such as itching or bleeding. Mole mapping with your dermatologist is the best way to identify evolving moles.
  • It is important to consult your doctor about any mole that is worrying you, even if none of the above-mentioned features are there. Additionally, bleeding from a mole and itching are also worrying symptoms.

Melanoma Treatments

Early-stage melanomas are usually treated with surgery to remove the melanoma. A very thin melanoma may be eradicated entirely during the biopsy, and no additional treatment is required. Otherwise, your surgeon will remove the malignancy, as well as a layer of tissue beneath the skin and a border of normal skin. Treatment options for melanoma that has gone beyond the skin include:

  • Lymph node dissection – a surgery performed to remove lymph nodes. Historically this was done based only on the depth of skin involvement of the melanoma. We now do sentinel node biopsies to identify the patients that need a lymph node dissection.
  • Immunotherapy
  • Targeted therapy
  • Radiation therapy
  • Chemotherapy


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Sentinel node biopsy:

A sentinel lymph node biopsy (SLNB) is a process that involves identifying, removing, and examining a sentinel lymph node to see if cancer cells are present. The sentinel node is identified by injecting a radioactive substance in the area where the melanoma is and then tracing radioactivity to the lymph node that is primarily responsible for all drainage of lymph (bodily fluid) and foreign material, in this case, cancer cells from that area. It is very helpful in determining which patients are at higher risk for systemic spread of the melanoma, and it is used to identify which patients will benefit from major lymph node dissection.

Lymph node dissection (block dissection)

In patients where the sentinel node biopsy shows cancerous cells within the sentinel node, a lymph node block dissection will generally be necessary. A block dissection involves removing all lymph nodes draining a specific area. This could be in the groin if the melanoma was in the leg or in the armpit or axilla if the melanoma was in the arm or hand. It can also be in the neck area if the melanoma was on the face or head. Lymph node dissections are major operations, carrying considerable inconvenience to the patient, but can be lifesaving. Since the advent of sentinel node biopsies, we offer lymph node block dissections only to patients that will benefit from it.

 

FAQ

1Who diagnoses melanoma?
Primarily a dermatologist diagnoses melanoma.
2What is a melanoma excision?
A melanoma excision is surgery that removes a melanoma from your skin with an adequate margin. Dr Bruwer often treats patients with melanoma in conjunction with a plastic surgeon if wide local excision requires reconstructive surgery. A wide local excision is usually done with a sentinel node biopsy if the melanoma is deeper than 0.75 mm.
3When should you worry about a mole or pigmented skin lesion?
A new or changing skin growth is the most crucial melanoma warning indicator. New growth or spot, or a change in the size, shape, or colour of a mole, could be a cause for concern.
4Who needs a sentinel node biopsy?
Doing a sentinel node biopsy is aimed at identifying the small group of patients that will benefit from radical lymph node block dissection. The histology of the skin lesion gives a good guideline if lymph node metastasis is a possibility. Patients with small metastatic deposits in the sentinel node and with no systemic metastasis (usually requiring a PET CT scan) will benefit most from the process of doing a sentinel node biopsy and subsequent radical lymph node block dissection.