Melanoma

Melanoma is the most serious type of skin cancer. It begins in skin cells called melanocytes.

Melanocytes are the cells that make melanin, which gives skin its color.

When people spend time in the sunlight, the melanocytes make more melanin and cause the skin to tan. This also happens when skin is exposed to other forms of ultraviolet light.

If the skin receives too much ultraviolet light, the melanocytes may begin to grow abnormally and become cancerous. This condition is called melanoma.

How and where does melanoma appear?

The first sign of melanoma is often a change in the size, shape, or color of a mole. But melanoma can also appear on the body as a new mole. Men most often find melanoma on the upper body, between the shoulders and hips as well as on their head and neck. Women often develop melanoma on their lower legs.

Those who have darker skin will find that melanoma can appear under their fingernails or toenails, the palms of their hands, or soles of their feet.

Although these are the most common places on the body for melanomas to appear, they can appear anywhere on the skin. It is important to always examine your skin to check for new moles or changes in moles.

Melanoma can be diagnosed on patients of all ages.

 

The chance of getting melanoma increases as you get older, but people of any age can get melanoma. In fact, melanoma is one of the most common cancers in young adults.

Each year, more than 50,000 people in the U.S. learn that they have melanoma.

Melanoma is a serious and sometimes life-threatening cancer. If melanoma is found and treated in its early stages, the chances of recovery are very good.

If it is not found early, melanoma can grow deeper into the skin and spread to other parts of the body. This spread is called metastasis. Once melanoma has spread to other parts of the body beyond the skin, it is difficult to treat.

A biopsy of the suspicious mole or growth will be done in the office to confirm the diagnosis.

Options for treatment of melanoma:

MOHS MICROGRAPHIC SURGERY

Using local anesthesia, the tumor is removed with a very thin layer of tissue around it. The layer is immediately checked under a microscope thoroughly. If tumor is still present in the depths or peripheries of this surrounding tissue, the procedure is repeated until the last layer examined under the microscope is tumor-free.

This technique saves the greatest amount of healthy tissue and has the highest cure rate, generally 98 percent or better. It is frequently used for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes, nose, lips, and ears. After removal of the skin cancer, the wound may be allowed to heal naturally or be reconstructed using cosmetic surgery methods.

EXCISIONAL SURGERY

After numbing the area with local anesthesia, we remove the entire growth along with a surrounding border of normal skin as a safety margin. The skin around the surgical site is then closed with stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all malignant cells have been removed.

The effectiveness of the technique does not match that of Mohs, but is highly effective.

CURETTAGE AND ELECTRODESICCATION

Using local anesthesia, the physician scrapes off the cancerous growth with a curette (a sharp, ring-shaped instrument). The heat produced by an electrocautery needle destroys residual tumor and controls bleeding. This technique may be repeated twice or more to ensure that all cancer cells are eliminated. It can produce cure rates approaching those of surgical excision, but may not be as useful for aggressive basal cell carcinomas or those in high-risk or difficult sites.

CRYOSURGERY

Tumor tissue may be destroyed by freezing with liquid nitrogen, without the need for cutting or anesthesia. The procedure may be repeated at the same session to ensure total destruction of malignant cells.

The growth becomes crusted and scabbed, and usually falls off within weeks. Cryosurgery is effective for the most common tumors and is the treatment of choice for patients with bleeding disorders or an intolerance to anesthesia.

PHOTODYNAMIC THERAPY

TOPICAL MEDICATIONS

Imiquimod is FDA-approved only for superficial basal cell carcinomas, with cure rates generally between 80 and 90 percent. The 5% cream is rubbed gently into the tumor five times a week for up to six weeks or longer. It is the first in a new class of drugs that work by stimulating the immune system.

5-Fluorouracil (5-FU) is also FDA-approved for superficial basal cell carcinomas, with similar cure rates to imiquimod. The 5% liquid or ointment is gently rubbed into the tumor twice a day for three to six weeks.

Trials with more invasive basal cell carcinomas are under way for both imiquimod and 5-FU. Side effects are variable, and some patients do not experience any discomfort, but redness, irritation, and inflammation are predictable.