Can Melanoma Be Cured
Melanoma that’s caught early, when it’s still on the surface of the skin, can be cured.
Untreated melanoma can grow downward into the skin until it reaches the blood vessels and lymphatic system. This lets it travel to distant organs, like the lungs or the brain. That’s why early detection is so important.
Most Melanoma Does Not Start In A Preexisting Mole
Melanoma can develop in a preexisting mole, says Dr. Marghoob, but nearly 70% of skin melanomas do not. Rather, they occur in normal skin. Moles themselves are not cancerous, and it is extremely rare for a mole to transform into a melanoma, says Dr. Marghoob. That said, he adds, having many moles helps identify people who are at an increased risk for developing melanoma somewhere on their skin.
Since most melanoma develops on normal skin, Dr. Marghoob stresses the importance of protecting the entire surface of the body, including areas with many moles and areas without any moles. Some people use sunblock only where they have moles because they think the moles themselves are dangerous, adds Dr. Marghoob. Stay safe by applying broad-spectrum sunblock with an SPF of at least 30, wearing sun-protective clothing, or using a combination of the two approaches.
How Acral Lentiginous Melanoma Is Treated
Casey Gallagher, MD, is board-certified in dermatology. He is a clinical professor at the University of Colorado in Denver, and co-founder and practicing dermatologist at the Boulder Valley Center for Dermatology in Colorado.
Acral lentiginous melanoma is a rare type of cutaneous skin cancer that develops on the palms of the hands, soles of the feet, and nail beds.
Unlike most skin cancer, it is not associated with sun exposure. ALM accounts for 70% of melanomas in Black people, 46% in Asian people, and less than 10% in White people.
When detected early, ALM can be cured by surgical removal. This procedure, called a wide local excision, is performed by a surgical oncologist and is the mainstay of treatment for most ALM lesions.
If the cancer has spread, additional treatments, such as chemotherapy, may be needed. In this article, we will review the treatment options.
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Physical Emotional And Social Effects Of Cancer
Melanoma and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the melanoma returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another part of the body .
When this occurs, a new cycle of testing will begin to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, chemotherapy, immunotherapy, targeted therapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
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Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a procedure to test for the spread of cancer.
It may be offered to people with stage 1B to 2C melanoma. It’s done at the same time as surgical excision.
You’ll decide with your doctor whether to have a sentinel lymph node biopsy.
If you decide to have the procedure and the results show no spread to nearby lymph nodes, it’s unlikely you’ll have further problems with this melanoma.
If the results confirm melanoma has spread to nearby nodes, your specialist will discuss with you whether further surgery is required.
Additional surgery involves removing the remaining nodes, which is known as a lymph node dissection or completion lymphadenectomy.
What Happens Next
Surgical removal offers the best chance of a complete cure, and this treatment alone is usually successful in thin melanoma. Most patients do not need radiotherapy or chemotherapy.
Once a diagnosis of melanoma has been made you will usually be offered a second surgical procedure to remove more skin from around and beneath the melanoma scar. This second procedure typically removes a further 1cm margin of skin around the first scar site. It is called a Wide Local Excision and is usually carried out under local anaesthetic. Your doctor will discuss with you how much skin will need to be removed as the recommended margin depends on the thickness of the melanoma. The purpose of this further surgery is to try and make sure that no cancer cells are left behind in the nearby skin.
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What Is A Biopsy
An excisional biopsy is a simple surgical procedure in which the lesion is removed and sent to a laboratory for analysis. Sometimes this might be done by your GP or by a specialist. You will be given a local anaesthetic and then a scalpel is used to remove the mole and some of the surrounding tissue. You may have stitches to help the wound to heal.
The tissue that is removed is sent to a pathology laboratory for examination and it takes one to two weeks to get the results a followup appointment may be arranged. You will find out if melanoma is present and what stage it is, how thick it is, and other information such as how rapidly the cells are dividing , ulceration, regression and excision margins.
If the tests show you have melanoma, you may have surgery to remove a wider margin of surrounding skin see page 15 for information on treatment.
If melanoma is confirmed and confined to the epidermis, then it is in situ if it has spread to the dermis it is invasive and if it has spread to other parts of your body it is metastatic.
Depending on the results of the biopsy additional testing may be recommended. This is more likely for thicker melanomas or if you have other risk factors.
Complications Caused By Treatment
The treatments for metastatic melanoma can cause nausea, pain, vomiting, and fatigue.
Removal of your lymph nodes can disrupt the lymphatic system. This can lead to fluid buildup and swelling in your limbs, called lymphedema.
Some people experience confusion or mental cloudiness during chemotherapy treatment. This is temporary. Others may experience peripheral neuropathy or damage to the nerves from the chemotherapy. This can be permanent.
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Treatment By Stage Of Melanoma
Different treatments may be recommended for each stage of melanoma. General descriptions by stage are below. Your doctor will recommend a specific treatment plan for you based on the stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this page. Clinical trials may also be a treatment option for each stage.
Stage 0 melanoma
Stage 0 melanoma is almost always treated with surgery alone, usually a wide excision.
Stage I melanoma
Stage I melanoma is usually treated with surgical removal of the tumor and some of the healthy tissue around it. The doctor may recommend lymph node mapping, and some lymph nodes may be removed.
Stage II melanoma
The standard treatment for stage II melanoma is surgery to remove the tumor and some of the healthy tissue around it. While this surgery is being done, lymph node mapping and sentinel lymph node biopsy may also be done. In some people with stage II melanoma, treatment with interferon may be recommended after surgery to lower the chances of the cancer coming back. Treatment in a clinical trial for stage II melanoma may also be an option. Ask your doctor about what clinical trials may be available for you.
Stage III melanoma that can be removed with surgery
The persons age and overall health
The locations and number of metastases
How fast the disease is spreading
The presence of specific genetic mutations in the tumor
The patients preferences
Treating brain metastases
The Visible Scars Of Melanoma
Unfortunately, people with metastatic disease might be going from treatment to treatment to treatment for years, says Smelko, but the melanoma world has recently exploded with a lot of great new treatments and more on the way. People are seeing great results and living for years. Its very promising. Those therapies include new biologic treatments that target different pathways of melanoma cell growth for advanced melanomas, as well as several different immune therapies and still-investigational combinations of systemic agents for melanomas that appear to have a worse prognosis, Cohen notes.Surviving melanoma can mean living with visible scars. In Brossarts case, Cohen and Contreras removed the melanoma, leaving a wound about the size of a silver dollar. Cohen then repaired this surgical defect with a large flap that mobilized skin from her lateral cheek all the way to her temple. The surgery to close the wound left a large triangular scar on her face that went from the outside corner of her left eye to the side of her nose and down to her left jaw.
It was scary to look in the mirror, recalls Brossart, who works at an elementary school in Castle Rock, Colorado. I wondered if I was ever going to be able to walk down the street and not stop traffic.
They did a fabulous job, she says now. I do see a scar when I look in the mirror. I think itll always be there, but it becomes the new normal. You look in the mirror, its there, and you dont think about it anymore.
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What Do We Mean By Stage Of Melanoma And Why Is It Important To Know
The stage of melanoma in the body is about how far advanced it is. This is important because:
Melanoma stages are determined by the thickness, depth and spread in the body. How far advanced the melanoma is when diagnosed influences a persons outcome.
For people who are treated early, when melanoma affects only the superficial layers of the skin, the prognosis is excellent and the disease is often curable. If the cancer spreads to other parts of the body it can be harder to treat.
StagesStage 0 – abnormal cells found in the epidermis. Stage 1 – the melanoma is not more than 2mm thickStage 2 – more than 2 to 4mm thick with no spread to the lymph vessels or lymph nodesStage 3 – any thickness that has spread to lymph vessels or lymph nodesStage 4 – the melanoma has spread to other parts of the body
How Dangerous Is Melanoma Its All A Matter Of Timing
Skin cancer holds the unfortunate distinction of being the worlds most common cancer. Though its prevalence around the globe is disturbing, there is some good news: When caught early, skin cancers are highly curable.
You might already know that catching a cancer early means a more favorable prognosis. But it can be difficult to comprehend just how big a difference early detection makes with melanoma, the most dangerous form of skin cancer. Melanoma should never be underestimated, but treating a tumor early rather than after it is allowed to progress could be lifesaving.
Leland Fay, 46, understands better than most the seriousness of this distinction. When the Monument, Colorado native was diagnosed with melanoma in 2012, he was given a bleak prognosis due to the advanced stage of the tumor it had already reached stage IV.
Leland hadnt thought much of the little black mole on his head a few months earlier, when a dermatologist froze it off during a routine exam. But the mole resurfaced, bigger than it had been originally. After a biopsy and imaging tests, doctors told Leland it was melanoma, and that it had already spread. He could have as few as six weeks to live.
To fully comprehend the significance of timing, it can be helpful to understand exactly what happens to a melanoma when it advances to a later stage, and what it means when a melanoma spreads beyond the original tumor site.
How Does A Doctor Know The Stage Of A Patient’s Melanoma
When your dermatologist found a spot on your skin that looked like a skin cancer, your dermatologist performed a skin biopsy. This involved giving you an injection to numb the area and then removing all the spot.
The skin that your dermatologist removed was then sent to a lab, where another doctor looked at it under a microscope. This doctor saw melanoma cells.
When a doctor, who is either a dermatopathologist or pathologist, sees melanoma cells, this doctor also tries to determine the stage of the melanoma. When its possible to figure out the stage, the doctor includes this information in your biopsy report. This is a report that the doctor writes and sends to your dermatologist. It explains what the doctor saw under the microscope.
Because the doctor sees only the skin that your dermatologist removed, your dermatologist also uses the findings from your complete skin exam and physical to help determine the stage of the melanoma.
Sometimes, more information is needed to determine the stage.
What They Look Like
Melanomas in situ tend to be flat and asymmetric with irregular borders. They can be black, brown, tan, gray or even pink if the person has very fair skin. Areas that receive the greatest sun exposure, such as the scalp, face and neck, are more likely to develop melanoma in situ than the arms or legs. However, non-sun exposed areas, such as the buttocks, are also at risk. We dont always understand the causes of these melanomas, though heredity can play a role. To detect melanoma in situ as early as possible, it helps to monitor your own skin. Head-to-toe self-examinations are a good place to start, including the areas where the sun doesnt shine. When evaluating your skin, focus on the ABCDEs of melanoma detection. A stands for asymmetry B for irregular borders C for more than one color D for diameter greater than 6mm , or the size of a pencil eraser and E for evolving, meaning any lesion that is new or changing. View helpful photos showing the ABCDEs of melanoma.
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Who Are They For
Not every patient has mutations in their melanoma that are affected by the drugs that are currently available or in trial. Part of treatment at Melanoma Institute Australia includes being tested for these mutations and pairing you with the best option for your situation.
Some of the drugs are still under investigation in clinical trial testing. That means that even though you might have the mutation that correlates to a drug, the trials inclusion criteria could still prevent you from qualifying. Take a look at the Clinical Trials section of this site to learn more about how trials work.
Treating Stage I Melanoma
Stage I melanoma is typically treated by wide excision . The width of the margin depends on the thickness and location of the melanoma. Most often, no other treatment is needed.
Some doctors may recommend a sentinel lymph node biopsy to look for cancer in nearby lymph nodes, especially if the melanoma is stage IB or has other characteristics that make it more likely to have spread. You and your doctor should discuss this option.
If the SLNB does not find cancer cells in the lymph nodes, then no further treatment is needed, although close follow-up is still important.
If cancer cells are found on the SLNB, a lymph node dissection might be recommended. Another option might be to watch the lymph nodes closely by getting an ultrasound of the nodes every few months.
If the SLNB found cancer, adjuvant treatment with an immune checkpoint inhibitor or targeted therapy drugs might be recommended to try to lower the chance the melanoma will come back. Other drugs or perhaps vaccines might also be options as part of a clinical trial.
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How Common Is Melanoma
Melanoma accounts for only about 1% of all skin cancers, but causes the great majority of skin cancer-related deaths. Its one of the most common cancers in young people under 30, especially in young women.
Melanoma incidence has dramatically increased over the past 30 years. Its widely accepted that increasing levels of ultraviolet exposure are one of the main reasons for this rapid rise in the number of melanoma cases.