Common Question about Malignant Melanoma

1.How can I tell if a skin growth is melanoma? Is there any special appearance that I should watch for?

Be alert for growths that ooze fluid or blood, crust or clot over, and then ooze or bleed again. A sore that doesn’t heal after a week or two may be cancerous. Be on the lookout for moles or skin spots that are:

• Bigger from edge to edge than a pencil eraser
• Have uneven or ragged edges
• Show combinations of more than one color especially red, white and blue/black
• Have a different appearance on one half than on the other

Those are warning signs of possible melanoma. Check with the doctor if they occur.

2.My wife was treated for melanoma. The dermatologist said it was so small and thin that the entire tumor was removed with the biopsy . He thinks that no other tests or treatment are needed. Yet I’ve heard that melanoma is very dangerous because it spreads. Should my wife have more tests?

Melanoma detected in an early stage often can be cured with an excisional biopsy. The biopsy removes all the cancer cells before the melanoma has had a chance to spread to other organs. If your wife had Stage I melanoma, the doctor seems to be following national guidelines on melanoma care if he removed a margin of normal tissue (e.g. 5 mm for in-situ melanoma). These guidelines state that extra tests or treatment are not needed for very early melanoma.

3.My friend read about a melanoma test that can show whether melanoma has spread to lymph nodes, and can pick out the exact nodes that have cancer cells. Should I ask the doctor about this test?

The test is a sentinel lymph node biopsy. Many doctors feel that it can help in more accurately deciding the stage of a melanoma. It usually begins with lymph node “mapping,” which identifies the exact lymph node basin where fluid from the tumor site drains. The fluid may carry cancer cells. Doctors biopsy the first node in the basin, remove it and have it examined for cancer cells. If positive the remaining nodes are removed. If the sentinel node is negative, it avoids the need to remove presumably normal lymph nodes.

4.What’s lymphedema ? My doctor said it might be a problem after she removes the lymph nodes in my underarm. They’ve found melanoma cells there.

Lymphedema is a backup of lymph, the clear fluid that flows from tissues in the body to lymph nodes. From the nodes, lymph drains into the bloodstream. When all of the lymph nodes in the armpit are removed, lymph accumulates and may cause painful swelling and other problems in the arm. Lymphedema is a lot less serious than cancer, of course. Sometimes it can be avoided. Lymph node mapping and a sentinel lymph node biopsy, for instance, can reduce the number of nodes that must be removed. Ask your doctor whether these tests may help in your own case.

5.How often should I return to the doctor for follow-up care after treatment for melanoma?

That depends on the stage of your melanoma and a lot of other individual factors. Doctors usually ask patients to return for a complete checkup every three months for the first two years after treatment. Each visit will probably include a complete skin examination, and a check for enlarged lymph nodes. Doctors may order a chest x-ray and scans of the lungs, brain, and other organs depending on symptoms.

6.My mother had melanoma. I’m worried that I may get it, too, especially because I have a lot of moles on my skin. What kind of medical checkups are recommended?

Melanoma does run in families. If your parents had melanoma, your own risk may be higher than normal – especially if you have many moles of a certain kind. Your primary care doctor or dermatologist should do a total skin examination at each routine physical examination. That involves inspecting every inch of your skin, including the genital region and the area between the buttocks. If the doctor spots suspicious growths, you’ll probably get a referral to a dermatologist. Once you know that your skin is normal, get in the habit of doing a skin self-examination to watch for new growths or changes in existing growths.

7.What is the best way of preventing melanoma?

Scientists don’t know for certain what causes melanoma. Many believe that too much exposure to the sun is the number-one cause. Try to avoid two kinds of exposure:

• Constant day-to-day exposure that occurs in people who work outdoors or enjoy outdoor sports or leisure activities.
• Less frequent but more intense exposure that causes sunburn. Vacationers, skiers, and others who get intense sun exposure a few times a year may be at high risk for malignant melanoma, the most serious kind of skin cancer.

8.Can malignant melanoma occur anywhere else on the body?

Although most pigment-producing cells are in the skin, some melanocytes occur in other parts of the body. These cells can also become malignant. Melanoma that begins in the eye is called ocular melanoma. Although the incidence is very rare, melanoma also can begin in the gastrointestinal tract, lymph nodes, brain, and other areas of the body.

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