Melanoma Pamphlet
  

Registered Charity

Number 284582

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Melanoma

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  Diagnostic and Staging Investigations
  
  Malignant Melanoma is a cancer, which usually starts in the skin. The cells either in pre-existing moles or normal looking skin begin to over produce, causing an alteration in skin appearance. This is usually noted as a changing mole, which is irregular in outline or c0l0ur. Although the cause is not fully understood, there is strong evidence to suggest that ultraviolet (UV) rays from the sun can do long term damage to the skin. This in turn may contribute to the development of malignant melanoma.
  
  It is recommended that all suspected malignant melanomas initially be diagnosed with surgery. This will involve removing the mole or the lesion, usually under a local anaesthetic. This operation is called an excisional biopsy. The sample is then sent away to confirm the diagnosis. It may take one to two weeks for the results of the biopsy to be ready.
  
  Usually no staging or investigations are needed before surgery. If however after the initial biopsy, the doctors find that the melanoma had grown into the deep layers of your skin, they may request you have a chest x-ray and scan of your liver. This is because there is a small chance that the melanoma could spread to your lymph glands or elsewhere in your body.
  
  Malignant Melanomas caught at an early stage of development have a good chance of a cure. When a melanoma is removed in surgery, one of the things that will be looked at under the microscope is how deep, or thick it is. The thinner the melanoma, the lower the risk of it spreading elsewhere in the body.
  
  Information about the Surgical Procedures
  
  If a melanoma is diagnosed as a result of a biopsy, the doctor will often carry out a wider excision. This involves another operation to remove an extra margin of skin from around the original melanoma site, which is again examined under a microscope. This greatly reduces the risk of any melanoma cells being left behind in the surrounding skin.
  
  If possible, the wound will be stitched closed although sometimes it is necessary to repair the area with a skin graft (see separate booklet) or other types of plastic surgery. You may require time to get back to your usual routine. This is often dependent on the type of surgery you have had; your surgeon will advice you of this.
  
  There is a small chance that your melanoma may spread or come back; this may be removed' by further surgery. Biological, chemotherapy or radiotherapy may also be used; but currently these are not used to treat primary melanoma.
  
  Laser treatments may also be used if the melanoma returns in the skin. High intensity lasers are directed at the affected areas and destroys any melanoma cells.
  
  Research and Clinical Trials are ongoing to find the best and new treatments. For up to date information, please ask your Skin Cancer Specialist Nurse.
  
  Follow up Regime/Plan
  
  What follow up will I require?
  
  Once surgery is complete, you will need to have regular check-ups. Regular check-ups at the hospital are important to detect any reoccurrence at the site of removal, or in the surrounding skin. Initially these may be as frequent as every two months or only every six months depending on your initial diagnosis. These will gradually tail off. For an individual timetable, please ask.
  
  Self Examination
  
  You will be taught to examine yourself. This is probably one of the most important things you can do to help yourself. However please be assured that the chance that the melanoma will return remains small for the majority of people.
  
  Ø Check for any existing or new moles or skin lumps that enlarge, change colour, bleed or itch. Most changes are harmless but they may indicate the start of a skin cancer. See your doctor if in doubt.
  
  Ø Any dark spots that develop either at or near the site of the removal of the melanoma should be reported to your doctor.
  
  Ø If any melanoma cells have broken away from the tumour before it was removed, there is a chance that they may spread to your lymph glands.
  
  Lymph glands are present throughout the body. They are there to fight off any infections. If the cancer cells escape (spread) from the melanoma, they can lodge in the glands (also called nodes). This may produce lumps, either painful or painless, in the neck, armpits or groins, depending on the site of the Initial growth.
  
  Ø Even more rarely, in a very small number of people the melanoma can spread beyond the local lymph nodes to distant nodes, distant skin, or other organs such as the lung, brain or liver.
  
  Any unusual symptoms that persist should be reported. If you would like more information on this, please discuss this with your Surgeon or the Skin Cancer Nurse. It is important to remember that recurrences may still be curable if detected early.
  
  How do I examine myself?
  
  Although your doctor at your check up will examine you, it is important that around once a month you must perform your own examination at home.
  
  Take time to look at, and feel the scar and the surrounding area. One of the easiest ways to do this is to feel with the flat of your hand against the skin, as opposed to squeezing the skin between your fingers. Many people find this works well whilst having a bath or shower. This same technique can be used to check the skin between the scar and the lymph nodes, and the nodes themselves.
  
  For melanomas in the head or neck area, the nodes in the side of the neck, under the chin, above the collarbones, behind the ears and at the back of the neck need to be examined.
  
  For melanomas occurring on the arm, spread may occur in the armpit on the affected side, above the collarbones and in the lower neck.
  
  For melanomas occurring on the leg, the nodes behind the knees and in the groin need to be checked. A useful tip is to compare one side of your body with the other.
  
  You should contact your GP, Consultant Secretary or Skin Cancer Nurse Specialist if you are worried. The phone numbers are Included in this diary. Don't be embarrassed that you are causing extra work. We would much rather see you or talk it over with you on the phone, and reassure you than have you worry and risk delaying treatment.
  
  Future Protection
  
  Take care whilst in the sun. Its recommended that you: -
  Wear Protective Clothing
  Never allow your skin to burn
  Wear a hat with a large brim
  Avoid strong sunshine during 11 am and 3pm if possible.
  Avoid using sun beds
  Use high factor sunscreens (SPF 15+)
  Sit in the shade
  
  Pass this message onto your friends and family about protecting themselves and checking alterations in moles and their skin. Remember, sunscreens should be used as well as, rather than instead of, all the above recommendations.