1. What exactly is a melanoma?
A melanoma is a cancerous growth of the cells that produce the pigment (melanocytes) in the skin. It can arise from a pre-existing mole (rarely) or can appear anew on normal skin.
- The major risk factor for developing melanoma is sun exposure, and especially sunburn.
- People with fair skin such as redheads and blondes (phototype 1 and 2) who expose their skin to the sun, are at a higher risk of developing melanoma than people with darker skin.
- People who have a family history of melanoma (a close relative with melanoma) are at higher risk of developing melanoma.
- People who have more than 50 moles on their bodies are at higher risk, especially if these are “atypical” moles.
Look out for:
- A – asymmetry
- B – borders becoming irregular
- C – colour change or development of black, red or blue in a mole
- D – diameter: mole enlarging.
The prognosis depends on the thickness of the melanoma. Melanomas that are thin (> 1mm thick) carry a graver prognosis.
It is therefore important that high-risk individuals have their skin checked regularly to detect a melanoma early, should one develop.
The melanoma will spread locally and destroy more tissue, making it even more complicated to remove later. You are also risking a regional spread to the lymph glands, so it is best to remove it completely at your earliest convenience.
Melanomas are treated by excision. The thicker the melanoma, the wider the excision needs to be. This is generally done by an experienced cancer surgeon/plastic surgeon.
- If a melanoma is >1mm thick, a sentinel node biopsy is done in order to stage the melanoma. The sentinel node is the first lymph node that could be affected by the spread of cancer cells from the melanoma.
- A patient who has a positive sentinel node (a node that contains melanoma cells) has a graver prognosis than a patient whose sentinel node is not affected.
- Immune modulators such as interferon alpha are sometimes used to treat more advanced melanomas.
- Chemotherapy is generally not given unless the melanoma has widely spread to other sites of the body.
There are new chemotherapy drugs available that have improved the life expectancy of patients with metastatic melanoma.
If the pathologist reports an incomplete excision, a wider excision or Mohs surgery is conducted, especially if it is on a cosmetically sensitive site. First excisions are, however, very successful and probably around 90%+ of them are successfully removed the first time. It is a fallacy that cutting aggravates a skin cancer. Once it is removed, it is completely removed.
A melanoma can be removed in your dermatologist’s rooms under local anaesthesia.
There will be a scar afterwards, however, we take utmost care to give you the best chance of a softer appearing scar by doing an excision in your natural folds to hide the mark.
In those cancers that are well demarcated, we can also consider injecting them with a localised chemotherapy; for the really shallow ones we can consider photodynamic therapy.
Scars can also be softened, should your skin produce keloid scars but ultimately that shouldn’t stop you from removing ever-enlarging cancer.
The local anaesthetic works out slowly over a few hours. Typically patients don’t complain of pain, perhaps just some mild discomfort at the most. We seldom prescribe any strong analgesia for post-op care. If you suffer from severe pain, you should contact your dermatologist.
No, these cancers respond best to surgery and are not sensitive to chemotherapy or radiation.
Patients who have had a melanoma should have follow-ups at least yearly for the remainder of their lives. In the early stages after a melanoma diagnosis, however, follow-up visits may have to be quarterly depending on the thickness of the melanoma.
- Expensive investigations are not necessary when the melanoma is thin and carries a good prognosis.
- Patients who have had thicker melanomas removed, and those who have positive lymph nodes, might need some of these tests done but your Oncologist will decide what is required.
Melanoma in children is very rare and usually does not present like adult melanoma. It is adequate to have children checked for the first time once they have been through puberty.
Black patients have a much lower risk of developing melanoma but melanoma can occur. There is a particularly aggressive melanoma that occurs on the palms/soles of black patients.
This is the most common form of cancer and can present many years after exposure to the sun.
The skin never ‘’forgets’’ what you did to it when you were younger; maybe even as far back as doing sport at school without wearing sunscreen, could have triggered it. You need to protect your skin from the sun, preferably with suitable clothing and sunscreen with an SPF 50+, and avoid spending time in the midday sun. It is not advisable to try to acquire a tan once you have had a melanoma. There is always a risk of developing another melanoma, especially if the skin continues to be sun-damaged.
There is no special diet to prevent melanoma, however, a healthy diet that includes fresh fruit and vegetables, cutting out refined carbohydrates, avoiding too much animal protein, and cutting out excess alcohol, is advisable. Smoking should be avoided and supplements, if taken, should include antioxidants.
The best advice can be provided by your dietician.