Dr. M. J. Bazos, Patient Handout
MELANOMA

About Your Diagnosis
Melanoma is a skin cancer that begins from melanocytes. Melanocytes are the cells that produce pigment. The number of new cases diagnosed in the United States has increased dramatically in the last 25 years. It is believed that the increase in melanoma is related to the increase in the amount of time people
spend in the sun. Ultraviolet radiation damages the skin and leads to melanoma. Persons at risk for melanoma are those who have fair skin, blue eyes, blond hair, and freckles and burn easily. The risk increases if a close family member has the disease or if one has many abnormal moles (atypical nevi). The best way to detect melanoma is to examine your skin from head to toe. You are looking for any new moles or for changes in any existing moles. When examining a mole, follow the rule of ABCD. Is the mole asymmetric? Does the mole have an irregular border? Does the mole have variations in color? Is the diameter of the mole increasing? The only sure way to diagnose melanoma is by means of biopsy. If detected early, approximately 85% of all melanomas are curable.

Living With Your Diagnosis
Most melanomas appear as new moles; however, some arise from an existing mole. The way melanoma grows and spreads is that at first the cells of the mole spread locally without penetrating deep into the layers of the skin. As the cancer continues to grow and goes undetected, the cells start to invade and penetrate deep into the skin, eventually spreading into the veins and lymph nodes. Melanoma commonly spreads to the liver, brain, lung, and bone. Signs and symptoms include the ABCD changes in a mole, swollen lymph nodes, shortness of breath with lung involvement, bone pain with spread to bone, and headache, seizures, visual disturbance with brain involvement.

Treatment
When a suspicious mole is found, a biopsy is performed. The biopsy is essential for determining the extent of the cancer (staging). The biopsy must show how thick the melanoma is and how deep the cancer has penetrated the skin (thickness and level of invasion). Once the diagnosis is confirmed with a biopsy, the physician looks for areas of swollen lymph nodes by means of an examination and orders blood tests, chest radiographs (x-ray), computed tomography (CT) of the head, and a bone scan to determine whether the cancer has spread. Treatment depends on the thickness and depth of the cancer, whether lymph nodes are affected, and whether there is spread to other organs. An operation is performed for all stages of melanoma. For early stages without spread to organs such as the liver, lung, or brain, a surgeon cuts a wide margin of skin to make sure all the cancer is removed. The decision to remove nearby lymph nodes depends on the stage of the cancer, and the patient discusses this with the surgeon. If there is spread to other organs, surgical therapy helps to alleviate symptoms but does not cure the disease. Radiation therapy is used primarily to relieve symptoms for patients whose melanoma has spread to other organs. Chemotherapy has not been very successful in the management of metastatic (spreading) melanoma. It is used primarily to alleviate symptoms. Immunotherapy with agents to stimulate the immune system to kill cancer cells can be tried, but it also has limited success.
The cure for melanoma that has spread has not been found; this emphasizes the importance of early detection.

The DOs
• Perform a skin self-examination at least once a month. Look at all moles on your body or any new moles that have developed.
• Use sunscreen that blocks the effects of the sun’s rays. Sunscreens with a sun protection factor (SPF) greater than 15 provide the best protection from the sun.
• Remember that therapy for malignant melanoma involves a team effort coordinated by a primary care physician working alongside a dermatologist, oncologist, and surgeon. Many decisions have to be made, including how much skin tissue should be removed, whether the nearby lymph nodes should be removed, and how to conduct followup care after surgical treatment.

The DON’Ts
• Do not forget the ABCD rule (asymmetry, border, color, and diameter).
• Do not stay out in the sun for long periods of time, especially if you burn easily.
• Do not delay if you see a mole that has changed or one that looks different.

When to Call Your Doctor
• If you are suspicious of any moles.
• If you feel any swollen lymph glands.
• If you have pain, fever, or drainage after surgical treatment.