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The most common cancer in young adults
Melanoma is an aggressive skin cancer that develops from pigment producing cells (melanocytes) and has the potential to spread to lymph nodes and distantly.
Symptoms
Melanomas can arise from anywhere in the body including the eyes and mucosal surfaces. Although they most commonly occur in exposed areas of skin, they can also occur in areas that receive little sun exposure such as the soles of your feet and fingernails.
The first sign of a melanoma is the development of a new pigmented or unusual appearing skin lesion, or the change in the appearance of a mole in adult life.
The ABCDE of melanoma can be used to help self assessment of skin lesions. Features to look for are and increase suspicion are:
- A is for assymmetry – moles that have irregular shapes.
- B is for irregular borders.
- C is for colour variegation – multiple colours, or uneven distribution in a lesion.
- D is for diameter – skin lesions larger than 6mm in diameter.
- E is for evolving – moles that have changed over time, or develop itching or bleeding.
When to see a doctor
If you have any suspicious skin lesion or a mole that has changed the first step is seeing a practitioner experienced with performing skin checks. An appropriate biopsy should then be performed.
Most commonly, this is an excisional biopsy with narrow margins, but occasionally in cosmetically sensitive areas or in larger lesions, a punch biopsy is performed. The biopsy and particularly the Breslow Thickness of the melanoma will guide appropriate treatment.
For melanomas thicker than 0.7mm, consideration of a sentinel lymph node biopsy procedure should be given. For definitive treatment, you should be seen by surgeon who can discuss the role of and offer a sentinel lymph node biopsy procedure to screen for any sign of spread of melanoma to the lymph nodes draining that area of skin.
Risk factors for developing melanoma include:
- Skin type: those with fair skin, blonde or red hair, light coloured eyes and multiple freckles have less protection against UV radiation.
- A history of sunburn (particularly in childhood).
- A history of exposure to excessive ultraviolet light, such as from tanning beds use.
- Having a large number of unusual moles (dysplastic naevi).
- A family history of melanoma.
- An impaired immune system confers a higher incidence of melanoma and other skin cancers.
The key diagnostic step for a suspicious lesion is getting a good biopsy and information from the pathology report. Other tests and investigation may include:
- Lymphatic mapping procedure – a nuclear medicine procedure to map the lymph nodes draining the affected skin site. This is usually done along with a wide excision and sentinel lymph node biopsy procedure.
- Ultrasound of regional lymph nodes.
- PET scan.
- MRI brain.
Your treatment will be tailored to the location of the melanoma, the clinicopathologic features of the melanoma, and the individual. Melanomas require adequate resection with 1-2cm margins. A sentinel lymph node biopsy procedure may be indicated for appropriate staging of a melanoma and eligibility for trials and access to immunotherapies.
For cosmetically and functionally sensitive area such as the head and neck, or hands, referral to a surgeon who can offer both appropriate oncologic resection and good aesthetic results should be sought. Reconstruction may require local skin flaps or skin grafts.
If there is any evidence of spread to regional lymph nodes, or distant spread you will be seen by a melanoma specific oncologist, and your case discussed in a multi-disciplinary meeting by specialists who collaboratively work out an individualised treatment plan.