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Melanoma: Diagnosis and treatment


If you find a spot or growth on your skin that you think could be a melanoma, don’t delay making an appointment to see a board-certified dermatologist. When caught early, melanoma is highly treatable.

See a board-certified dermatologist

Dermatologists use tools, such as a dermatoscope, to help them get a close look at a suspicious spot.

How do dermatologists diagnose melanoma?

When you see a board-certified dermatologist, your dermatologist will:

  • Examine your skin carefully

  • Ask questions about your health, medications, and symptoms

  • Want to know if melanoma runs in your family

If any spot on your skin looks like skin cancer, your dermatologist will first numb the area and then remove all (or part) of it. This can be done during an office visit and is called a skin biopsy. This is a simple procedure, which a dermatologist can quickly, safely, and easily perform.

Having a skin biopsy is the only way to know for sure whether you have skin cancer.

The tissue that your dermatologist removes will be sent to a lab, where a doctor, such as a dermatopathologist, will examine it under a high-powered microscope. The doctor is looking for cancer cells.

What this doctor sees while looking at your tissue will be explained in the pathology report, including whether cancer cells were seen. If melanoma cells are seen, the report will include many important details, including:

  • The type of melanoma

  • How deeply the melanoma tumor has grown into the skin

  • How quickly the melanoma cells are growing and dividing

If it’s possible to tell the stage of the melanoma, the report will include this information.

Stages of melanoma

Here’s an explanation of what each stage of melanoma means:

Stages of melanoma

Stage 0
Also called melanoma in situ, this means the cancer occurs in the top layer of skin.

Stage 1
The cancer is found only in the skin, but the tumor has grown thicker. In stage 1A, the skin covering the melanoma remains intact. In stage 1B, the skin covering the melanoma has broken open (ulcerated).

Stage 2
The melanoma has grown thick, with the thickness ranging from 1.01 millimeters to greater than 4.0 millimeters. While thick, the cancer has not grown deeper than the skin or spread to nearby skin.

Stage 3
The melanoma has spread to either:
• One or more nearby lymph node (often called a lymph gland)
• Nearby skin

Stage 4
This is the most advanced stage. It means that the melanoma has spread to one or more parts of the body: An internal organ, such as a lung or the brain; lymph nodes that are not right next to the melanoma; or skin far from where the melanoma first appeared.

It’s not always possible to determine the stage of the melanoma from the biopsy, and it’s essential to know the stage of the melanoma. The stage determines how to treat the melanoma.

When the stage cannot be determined from the biopsy, your dermatologist will recommend more testing.

In some cases, the recommended testing may include a sentinel lymph node biopsy (SLNB) to help determine the stage of the melanoma.

You can learn more about a SLNB at, I have melanoma! Why do I need a sentinel lymph node biopsy?

Once the stage is known, the next step is treatment.

How is melanoma treated?

The type of treatment you receive depends on the following:

  • How deeply the melanoma has grown into your skin

  • Whether the cancer has spread to another part of your body

  • Your overall health

Your dermatologist, oncologist (cancer doctor), or oncology (cancer) team will consider the above when creating your treatment plan, which may include one or more of the following treatments.

Surgery: When treating melanoma, doctors strive to remove all the cancer. Because surgery (aka surgical removal) tends to be the most effective way to do this, a patient who has melanoma will often have surgery.

The type of surgical removal you receive depends largely on the type of melanoma you have, where it’s located, and how deeply it goes. If you have an early melanoma, your dermatologist may treat it with one of the following procedures, which can be performed in a medical office while you remain awake.

  • Excision: Your dermatologist cuts out the cancer and an area of normal-looking skin around the tumor. Removing some normal-looking skin helps to remove stray cancer cells.

    What your dermatologist removes will be looked at under a microscope. This time the doctor is looking for cancer cells in the normal-looking skin. Your treatment is complete if the normal-looking skin contains no cancer cells.

    If cancer cells are found in the normal-looking skin, you will need more treatment.

  • Mohs (pronounced moes) surgery: If you have melanoma on your head, neck, or hand, it can be difficult to remove an area of normal-looking skin. There just isn’t a lot of extra skin on these parts of the body.

    In this case, Mohs surgery may be an option.

    During Mohs surgery, you remain awake while a Mohs surgeon removes the least amount of tissue required to treat the cancer. This is possible because the surgeon can see where the cancer stops during the surgery.

    To learn more about what’s involved in having surgery and when it’s recommended, go to What is Mohs surgery?

If surgery can remove the cancer, this may be your only treatment. This is often the case with an early melanoma.

When melanoma grows deeper into the skin or spreads, treatment becomes more complex. Surgery may be part of your treatment plan, but other treatments will be used as well to help kill cancer cells. Some are given before surgery to shrink the cancer. Others are given after surgery to kill any remaining cancer cells.

The other types of treatment for melanoma are:

  • Lymphadenectomy: Surgery to remove lymph nodes.

  • Immunotherapy: Medication is used to help the patient’s immune system find and destroy cancer cells. This may be used after surgery. Sometimes, it’s used as the primary treatment when surgery cannot remove the cancer.

  • Targeted therapy: These drugs target cancer cells and can temporarily shrink the cancer.

  • Chemotherapy: These medications kill fast-growing cells, which include cancer cells and some normal cells, such as hair cells. Since the approval of newer medications, such as immunotherapy and targeted therapy, chemotherapy is used less often today.

  • Radiation therapy: This is used to either kill the cancer cells or stop new cancer cells from forming.

Other treatments that may be recommended include:

  • Clinical trial: A clinical trial studies a medicine or other treatment. A doctor may recommend a clinical trial when the treatment being studied could help you. Being part of a medical research study has risks and benefits.

    You should discuss the possible risks and benefits with your doctor before deciding whether to join a clinical trial.

  • Adoptive T-cell therapy: This treatment uses the patient's immune system to fight the cancer. Instead of receiving medicine, the patient has blood drawn. The blood is sent to a lab so that the T-cells (cells in our body that help us fight cancers and infections) can be removed. These T-cells are then placed in a culture so that they can multiply.

    Once the T-cells are ready, they are injected back into the patient. Some patients with advanced melanoma have had long-lasting remission with this treatment. This therapy, however, is not widely available.

  • Palliative care: This care can relieve symptoms and improve a patient’s quality of life. It does not treat the cancer. Many patients receive palliative care, not just patients with late-stage cancer.

    When melanoma spreads, palliative care can help control the pain and other symptoms. Radiation therapy is a type of palliative care for stage IV (has spread) melanoma. It can ease pain and other symptoms.

What is the life expectancy for someone who has been diagnosed with melanoma?

If you have melanoma, many factors affect your life expectancy. Your age, other medical conditions, and stage of the melanoma are just a few factors. For this reason, it’s impossible to predict how long one person who has melanoma will live.

What researchers do instead is predict how long a group of people who have melanoma will live. This is called “survival rate.” If you come across this term while looking for information about melanoma, it is important to know what this means.

Survival rate is “the percentage of people who will be alive within a certain time period, such as 5 years, after being diagnosed with a certain stage of melanoma. Each stage of melanoma has its own survival rate.

Before you search for the melanoma survival rates, it’s important to keep the following facts in mind:

  • Survival rates are estimates.

  • Each person diagnosed with melanoma has unique characteristics, so your outlook may be very different from someone else who has the same stage of melanoma.

  • Newer treatments, such as immunotherapy and targeted therapy, are helping people live longer.

Another important consideration is your self-care after treatment. Protecting your skin from the sun and never tanning can help prevent a new melanoma. Yet, studies reveal that many people continue their old habits after treatment and never protect their skin from the sun.

Finding a new (or returning) melanoma early can also help.

You’ll find out what dermatologists recommend when it comes to protecting your skin and finding melanoma early at, Melanoma: Self-care.


Image
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References
Barnhill RL, Mihm MC, et al. “Malignant melanoma.” In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 140-167.

National Comprehensive Cancer Network. “NCCN guidelines for patients: Melanoma.” 2018. Last accessed February 12, 2019.

Swetter SM, Tsao H, et al. “Guidelines of care for the management of primary cutaneous melanoma.” J Am Acad Dermatol 2019;80:208-50.

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