Skin Cancer Surgery - Malignant Melanoma

What is malignant melanoma and what causes it?

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 colour. It is an uncommon skin cancer, however it is the most serious.

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.

What types of treatment are used?

Malignant melanomas are usually treated with surgery. This will involve removing the complete tumour along with an area of normal skin. It may take two weeks or more for the results of the surgery to be ready and if this confirms that it has been entirely removed this may be all that is required. If a melanoma is not entirely removed, or if it is not certain, the doctor may carry out a wider excision - removing a further margin of skin from the original site. This is again examined under a microscope to ensure that no cancer cells have been left in the skin. This greatly reduces the risk of the melanoma recurring.
Sometimes it is necessary to repair the area with a skin graft or other types of plastic surgery.
There is sometimes a chance that the melanoma may have spread to your lymph nodes. Lymph nodes are present throughout the body. They are there to filter out and fight off any infections or bad cells. If the cancer cells escape (spread) from the melanoma, they can lodge in the lymph nodes (also called lymph glands). This may produce lumps, either painful or painless, in the neck, armpits or groins depending on the site of the initial growth.
Sometimes the doctors may recommend that a lymph node or nodes are removed at the time of surgery to check if there has been any spread to these areas.

Is there further treatment I may need?

The best treatment for melanoma is surgery. Following this no further treatment or investigations are usually required. However, it is possible for malignant melanoma to spread to other parts of the body, and if this happens further investigation and treatments may be needed. These can include surgery, radiotherapy, immunotherapy or chemotherapy.
Research and clinical trials are ongoing, to develop newer and more effective treatments for melanoma, which you may be eligible for depending on your diagnosis. If you want to know more, please ask for further details.

What is the future?

Malignant melanomas caught at an early stage of development have a very good chance of a cure. When the 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. In Britain most people are diagnosed with a melanoma of less than 2mm in thickness, which have a very good chance of a cure.

Regular check-ups at the hospital are important to detect any recurrences at the site of removal, or in the surrounding skin. Any dark spots that develop either at or near the site of the removal of the melanoma should be reported to your doctor.
In a very small number of people the melanoma can spread beyond the local lymph nodes to distant lymph 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 doctor or the skin cancer nurse.

It is important to continue to examine your skin for any abnormal growths to detect early warning signs, and to be aware of things you can do to help yourself.

• 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.
  
• Take care whilst in the sun, by wearing protective clothing and using high factor sunscreens (SPF 15+). Wearing a hat with a large brim is recommended.
  
• Avoid strong sunshine during 11am to 3pm if possible. Avoid using sunbeds.
  
• Pass on the message to friends and family about protecting themselves and checking alterations in moles and their skin.
  
• It is particularly important to protect children from strong sunlight.

What follow-up will I require?

Once surgery is complete, you will need to have regular check-ups. Initially these may be every three months or only every six months depending on your initial diagnosis. These will gradually tail off. For an individual timetable, please ask.

How will I feel after my surgery?

There is no right or wrong way to feel. The diagnosis of cancer can produce a wide range of feelings, from shock and disbelief to anger and blame. This does not mean that you are not coping with living with cancer.