Melanoma – Diagnosis and Treatment
A team of specialists helps diagnose and treat melanoma. These experts include a medical oncologist, surgical oncologist, radiation oncologist, and pathologist.
The medical oncologist manages medication-based treatments. The surgical oncologist removes the tumor.
A radiation oncologist provides radiation therapy if needed. The pathologist examines tissue samples under a microscope to identify the stage and type of cancer.
Key risk factors for melanoma include frequent sun exposure, tanning bed use, and a history of severe sunburns. People with many moles or unusual moles also have a higher risk.
Diagnosis
Medical History and Skin Check
A healthcare provider asks about your past health and examines your skin. The provider looks for unusual moles or lesions that could be melanoma.
Doctors check the size, shape, color, and texture of spots. They also examine other areas for more signs of melanoma, such as different subtypes like superficial spreading or nodular melanoma.
Tissue Sampling for Laboratory Analysis
Doctors remove a small piece or the whole skin lesion for testing. They use a circular blade (punch biopsy) or a scalpel (excisional biopsy) to get tissue samples from a suspicious mole.
These tests confirm if the cells are melanoma or another skin issue.
Assessing How Far Melanoma Has Spread
After diagnosis, doctors use imaging scans or a sentinel lymph node biopsy to see how deep the melanoma goes and if it has spread. The results guide treatment planning.
Melanocytes are skin cells that make pigment. Melanoma develops when these cells become damaged by UV light and start to grow uncontrollably.
If not found early, melanoma can spread to other parts of the body. It usually spreads first to nearby lymph nodes, which filter harmful substances.
Doctors measure the thickness of melanoma to choose the best treatment plan. A pathologist checks this under a microscope.
Thinner melanomas may need only minor surgery. If the melanoma is thicker, doctors check if it has entered the lymph nodes with a sentinel lymph node biopsy.
In this test, doctors inject a dye near where the tumor was removed. The dye travels to the nearest lymph nodes, called sentinel nodes, which are then checked for cancer cells.
If doctors find worrying signs, they may order scans like X-ray, MRI, CT, or PET to look for spread to organs such as the lungs or liver.
They also examine if the melanoma has broken through the skin’s surface (ulceration) or if the cancer cells are dividing quickly (high mitotic rate).
Melanoma staging runs from 0 to 4:
| Stage | Description | Prognosis |
|---|---|---|
| 0–1 | Tumor thin, small, no spread | High chance of recovery. |
| 2 | Deeper, possibly larger, still localized | Good prognosis if treated. |
| 3 | Spread to nearby lymph nodes | More difficult to treat. |
| 4 | Spread to other organs | Treatment is complex. |
Treatment often takes place in a specialist cancer center where experts work together. They guide patients and create tailored plans.
Treatment
Removing the Tumor Through Surgery
Doctors usually start melanoma treatment by cutting out the cancer. If the melanoma is small and thin, removing it during a biopsy may be enough.
In other cases, doctors remove the tumor and some normal-looking skin around it to make sure all cancer cells are gone. For deeper melanomas, doctors may take out nearby lymph nodes in a procedure called lymph node dissection.
Removing lymph nodes can lower the risk of cancer spreading. Sometimes surgery is the only treatment. If the cancer is more advanced, a team of specialists may suggest other methods to remove all cancer cells.
Key points for surgical melanoma care:
- Surgery is usually the main treatment.
- Small, early melanomas might only need simple removal.
- Deeper melanomas or those near lymph nodes often need wider surgery.
Using Energy Beams Against Cancer
Doctors use radiation therapy to destroy cancer cells with focused energy. The energy comes from sources like X-rays or protons.
Patients lie still while a machine aims energy at spots where cancer is found or may have spread.
Radiation can help after surgery if doctors worry that cancer remains in the lymph nodes. For melanomas that cannot be fully removed or have spread far, radiation may control symptoms and slow cancer growth.
| Radiation Uses | Purpose |
|---|---|
| After main surgery | Kill cells left behind in lymph nodes |
| When surgery not possible | Target hard-to-reach melanomas |
| To relieve symptoms | Help with pain or problems from spread cancer |
Strengthening the Body’s Defense With Immunotherapy
Doctors use immunotherapy medicines to help the immune system fight melanoma cells. Cancer cells often avoid the body’s defenses, but immunotherapy can help the immune system recognize and attack them.
Immunotherapy is often used when melanoma has moved to lymph nodes or other body parts. Medications like checkpoint inhibitors, such as ipilimumab, help immune cells attack the cancer.
Sometimes these treatments are given after surgery. Other times, doctors may put medicine directly into a tumor.
- Immunotherapy helps if cancer has spread.
- Some medicines remove camouflage from cancer cells.
- This treatment is often part of a plan for advanced melanoma.
Medications That Target Cancer Cell Changes
Doctors use targeted therapy drugs to block certain changes in melanoma cells. These drugs stop growth signals that help melanoma cells survive.
Doctors test melanoma tumor samples to see if targeted medicines might work. These treatments are usually recommended when melanoma spreads to lymph nodes or farther.
Targeted therapy can be a main part of treatment if specific genetic changes are found in the cancer cells.
Examples of targeted therapy benefits:
- Attacks only cells with certain changes.
- May work when other treatments do not.
- Often causes fewer side effects than traditional chemotherapy.
Cancer Treatment With Strong Medicines
Doctors use chemotherapy to destroy cancer cells with powerful drugs. These medicines can be given through a vein or as pills.
Chemotherapy is less common for melanoma but may help if immunotherapy or targeted drugs do not control the cancer.
In some cases, doctors use isolated limb perfusion. They temporarily separate blood flow in an arm or leg from the rest of the body and send chemotherapy just to that limb.
This lets doctors use a higher drug dose with fewer side effects for the rest of the body.
| Chemotherapy Facts | Details |
|---|---|
| How it’s given | Intravenously (IV), orally, or to a limb |
| When it’s used | After other options stop working |
| Special techniques | Limb perfusion for affected arms or legs |
Doctors may suggest these methods alone or in combination, depending on the cancer’s stage and the advice from the care team. The treatment plan is tailored for each person.
Ways to Manage and Find Support
Get Informed to Make Care Decisions
Learning about melanoma, including test results and available treatments, helps people make informed choices. Asking questions prepares you to take part in care decisions.
It can help to seek a second opinion if there’s any doubt about diagnosis or treatment options.
| What to Ask | Who to Ask |
|---|---|
| Test results | Healthcare team |
| Treatment options | Healthcare Provider |
| Prognosis | Specialist doctor |
Taking notes during appointments or asking for written information can help.
Rely on Relationships and Support Networks
Strong connections with friends and family make tough times easier. They can help with rides to appointments or daily tasks at home.
Emotional support from close ones helps manage stress and difficult feelings. Building a support network can ease the burden.
- Ask for help with chores.
- Stay connected by phone or video calls.
- Accept offers of support.
Talk to Someone Who Will Listen
Sharing thoughts and feelings with someone is helpful. Support groups, counselors, or trusted community members can provide understanding.
Talking openly can reduce feelings of isolation and make coping easier.
Getting Ready for Your Visit
Being well prepared can help you get the most from your visit. Here are ways to make your appointment smoother and more helpful:
List Any Instructions or Restrictions
Ask if you need to follow any special rules, like skipping certain foods or stopping medicines for tests, when you set your appointment. Write these instructions down so you don’t forget.
Track Your Symptoms
Use a notebook or your phone to note any signs or changes you notice. Include even small things that may not seem related.
You can use a simple table to stay organized:
| Symptom | When It Started | How Often | Notes |
|---|---|---|---|
| New mole | 2 weeks ago | Daily | Itchy at times |
| Skin color change | 1 month ago | Weekly | No pain |
Personal and Medical Details
Write down any major life events or stresses that happened recently. List any health problems or surgeries.
Make a list of all medicines, vitamins, and supplements you take. Include the dosage for each one.
Bring a Friend or Family Member
If you bring someone with you, they can listen, take notes, and help you remember what the doctor says. Support from a friend or family member can also help you feel more comfortable.
Questions to Ask
Prepare a list of questions to cover important topics. Put the most urgent questions at the top in case you run out of time.
Questions you might ask:
- Is my diagnosis melanoma?
- How big and deep is the melanoma?
- Has the melanoma spread?
- What tests do I still need?
- What treatments are available for me?
- What are the side effects of those treatments?
- Which treatment do you recommend?
- Is there time to think over my options?
- Should I consult a specialist? Does insurance cover this?
- What signs would mean I need a follow-up?
Leave space on your list for new questions that come up during your visit.
Stay Organized
Bring your notes, medication list, and written questions to your appointment. This helps you talk with the doctor and makes sure you don’t forget important information.
