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 almost always 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.
Goals Of Skin Cancer Reconstruction
Patients suffering from skin cancer of the face have a very difficult challenge. Not only do these patients have to deal with cancer, but the treatment and removal of that cancer affects the very feature that defines their identity their face. Unfortunately, the damage caused by skin cancer can never be completely undone, and no surgery on the skin can be performed without leaving a scar. However, reconstruction of facial skin cancer defects should aim to return the individuals facial form and function to as close to normal as possible so that individual is not left with permanent consequences from a cured skin cancer.
Surgery To Remove Skin Cancer
Most small skin cancers are removed in a minor operation called an excision. It is usually done using a local anaesthetic and you can go home on the same day.
The surgeon or dermatologist will remove the cancer and some normal-looking skin around it . The normal-looking skin is checked under a microscope to make sure all the cancer has been removed. You will have a dressing over the wound.
A type of surgery called Mohs micrographic surgery may sometimes used. Some people have a type of surgery called curettage and electrocautery to remove small skin cancers.
If the cancer is large or has spread, the surgeon may need to remove a larger area of skin. This is called a wide local excision. You have this done under a general anaesthetic.
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Risks Associated With Untreated Melanoma
Melanoma makes up a very small percentage of overall skin cancer cases. However, melanoma is responsible for over half the annual deaths attributed to skin cancer. Dr. Truong says, Melanomas are an aggressive and quickly evolving form of cancer. Its the most likely to grow quickly and metastasize. A treatment plan should be formulated as soon as possible. When caught and treated early, melanoma has a high cure rate, but when treated in later stages, cure rates drop drastically, especially if the cancer has metastasized.
Within six weeks of initial development, melanoma can become life-threatening, therefore, early treatment is extremely important. In order to access treatment in the earliest stages, patients need to know what to look for. Melanoma develops from the melanocytes, cells that create the skins pigment. For this reason, patients will need to carefully note any existing or new moles, freckles, or dark spots on the skin, assessing the area for the ABCDEs: Asymmetry, uneven Border, inconsistent or unusual Color, Diameter greater than the size of a pencil eraser, and any areas that are Evolving or changing.
What Is The Purpose Of Mohs Surgery
Mohs surgery is a painstaking procedure. It requires microscopic analysis of tissue cells while the surgery is taking place. The borders of each thin layer of tissue are analyzed for potential malignancy as they are removed horizontally. This technique is designed to remove the entire tumor with minimal amounts of healthy tissue. This results in less disfigurement. For this reason, Mohs surgery is ideal for removing skin cancers from the face, ears, or genitals.
The procedure is highly effective for skin cancers that have high rates of recurrence. Its also effective on aggressive or large lesions. Mohs surgery is also used when lesions have ill-defined borders.
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What Are The Risks
Flap or graft repairs will leave a scar. Your surgeon will plan the repair to minimize scarring.
Possible complications of this procedure are:
- Skin graft does not develop its own blood vessels and dies.
- Problems develop with the blood supply to the flap.
- Donor or recipient site becomes infected.
- Incision opens up.
It can be difficult to re-treat the area after the tissue has been rearranged. For this reason, it is important to be sure that the margins are clear.
Risks Of Curettage And Electrodesiccation
Risks associated with curettage and electrodesiccation are typically minimal if performed by an experienced doctor. Complications can include:
- Pain, swelling, crusting or bleeding at the affected site
- Scarring that can be painful and itchy long term
- Recurrence of cancer
- Cure rate is not as high as other procedures like Mohs surgery
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Surgery For Metastatic Melanoma
If melanoma has spread from the skin to other organs such as the lungs or brain, the cancer is very unlikely to be curable by surgery. Even when only 1 or 2 areas of spread are found by imaging tests such as CT or MRI scans, there are likely to be others that are too small to be found by these scans.
Surgery is sometimes done in these circumstances, but the goal is usually to try to control the cancer rather than to cure it. If 1 or even a few metastases are present and can be removed completely, this surgery may help some people live longer. Removing metastases in some places, such as the brain, might also help prevent or relieve symptoms and improve a personâs quality of life.
If you have metastatic melanoma and your doctor suggests surgery as a treatment option, be sure you understand what the goal of the surgery would be, as well as its possible benefits and risks.
Leaving Basal Cell Carcinoma Untreated
Basal cell carcinoma is a slow growing cancer, but this doesnt mean it can be ignored. This is the least dangerous form of skin cancer and rarely spreads to other internal parts of the body. While death is a rare consequence there is the potential for disfigurement. Over time basal cell carcinoma can expand and cause ulcers and damage the skin and tissues.
Any damage could be permanent and have an impact on the way you look. Depending on how long the basal cell carcinoma has been present, radiotherapy may be required. This is the most common form of skin cancer and is often found on the face. You may notice a small lump which is shiny or pearl like and this is a sign you should get checked. This type of cancer generally does not cause any pain.
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Healing By Secondary Intention
Secondary intention healing involves allowing the wound to heal spontaneously without suturing the edges together. During the healing time the wound needs to be cleaned regularly and ointment is typically applied several times per day to keep the wound moist. Depending on the size of the wound, healing can take weeks to months to complete, but eventually the open wound is covered with a new layer of skin that has grown in from the edges. Wounds that heal by secondary intention typically have more scar contraction and may have a lighter color or slight depression in height compared to surrounding skin. For most locations of the head and neck, secondary intention is not an ideal method of wound closure for these reasons. In specific circumstances, however, secondary intention healing may be recommended as a simple method of wound closure that does not require sutures or additional incisions.
Seek Comprehensive Care If Your Skin Cancer Is Complicated To Treat
Complicated skin cancer may require the expertise of multiple specialists. Plastic surgeons may get involved when the cosmetic challenges are significant. An ocular surgeon or an oculoplastic specialist may be needed if you have an especially difficult-to-treat skin cancer close to the eye. A head and neck surgeon may join your care team if there is nerve involvement or if the cancer is too extensive for local anesthesia.
The beauty of a comprehensive cancer center like MSK is that the expertise is all here, says Dr. Lee. We have a multidisciplinary program especially for people with complex skin cancer. You can usually see all of your doctors on the same day and in the same location. The dermatology team works with you to coordinate your appointments with your schedule.
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How Do You Treat Skin Cancer On The Nose
The nose is a relatively common spot for skin cancer to develop. Skin cancer often starts on the face because it’s usually the body part that’s exposed to the sun. The two most common types of skin cancer that develop on the nose are basal cell carcinoma and squamous cell carcinoma . While both types of skin cancer should be addressed right away, BCC is usually slow-growing and SCC grows more quickly. Basal cell carcinoma is the most common type of skin cancer ,with about 80% of cases occurring on the face and 25 to 30% on the nose.
The third type of skin cancer, melanoma, is rare and much more serious. It almost always requires excisional surgery to remove it. Fortunately, most forms of skin cancer are very treatable, especially when caught early. Treatment may include surgery, radiation, topical treatments, and more.
What Does Skin Cancer Look Like
Because many types of skin cancer can mimic the appearance of a mole or freckle, cancerous lesions or tumors can often be overlooked until they are at an advanced stage. New or suspicious-looking moles, freckles and growths should always be examined by a dermatologist and may be sent to a plastic surgeon for removal.
For melanoma specifically, the classic ABCDEs of melanoma diagnosis are:
- Asymmetry: If you were to split the growth in half, the two sides would not be mirror images of each other
- Border: Melanomas have irregular borders
- Color: Melanomas usually have more than one color, as opposed to benign skin growths
- Diameter: Melanomas are typically bigger than the average mole or freckle
- Evolution: Unlike noncancerous skin growths, melanomas will get bigger over time
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Risk Of Further Melanomas
Most people treated for early melanoma do not have further trouble with the disease. However, when there is a chance that the melanoma may have spread to other parts of your body, you will need regular check-ups.
Your doctor will decide how often you will need check-ups everyone is different. They will become less frequent if you have no further problems.
After treatment for melanoma it is important to limit exposure to the sun’s UV radiation. A combination of sun protection measures should be used during sun protection times .
As biological family members usually share similar traits, your family members may also have an increased risk of developing melanoma and other skin cancers. They can reduce their risk by spending less time in the sun and using a combination of sun protection measures during sun protection times.
It is important to monitor your skin regularly and if you notice any changes in your skin, or enlarged lymph glands near to where you had the cancer, see your specialist as soon as possible.
Laser Surgery Is Not Fda
Laser surgery is not currently used as a standard treatment for basal cell carcinoma or squamous cell carcinoma. It can, however, be an effective secondary treatment. Laser treatment is sometimes used after Mohs surgery to complete the removal of cancer cells. Lasers are effective at removing precancerous lesions, but have not been proven effective at treating cancer yet.
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What To Expect After Your Skin Cancer Removal Procedure
If the margins are cancer-free, the surgery is complete and the wound is stitched up. If not, the process is repeated until the site is completely clear of cancerous cells.
A simple wound dressing is placed over the surgical area. Healing time is minimal, depending on the size of the wound.
When they leave, patients say, Wow, this wasnt so bad. Theyre pleasantly surprised at how straightforward it is, Dr. Gastman says. They come in wondering how to get rid of skin cancer, and in almost all cases, leave satisfied.
Is Mohs surgery right for you?
Not all skin cancers need to be treated with a Mohs surgery.
Skin cancers are most common on the head and neck and often treated with Mohs, but those on the trunk and extremities are only treated with Mohs surgery under certain circumstances that your surgeon can determine, Dr. Gastman says.
Another kind of skin cancer called melanoma isnt usually treated with Mohs surgery because it is biologically different from basal cell and squamous cell carcinomas, says Dr. Gastman.
Mohs surgery, though, is the single most effective technique for completely removing the most common kinds of skin cancer. Because the surgery can be accomplished relatively quickly with instant feedback on the success of removing the cancerous cells, the procedure brings many patients peace of mind.
Its a really fabulous way of getting the cancer out and the patient knowing its out, he says.
Facial Skin Cancer Reconstruction
Skin cancer is the most common type of cancer affecting humans and is most commonly caused by cumulative sun exposure throughout a persons lifetime. Skin that is exposed to sunlight is the most susceptible to skin cancer formation, making the face one of the most likely sites for skin cancer to develop. The three main types of skin cancer include basal cell carcinoma, squamous cell carcinoma, and melanoma. The severity of these cancers can range from very small, superficial lesions that can be cured with topical or cryotherapy to large, invasive tumors that can spread throughout the body and require extensive surgical resection and potentially even radiation or chemotherapy. For this reason, all suspicious skin lesions or areas of ulceration that do not heal should be taken seriously and evaluated promptly.
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Stages Of Skin Cancer
If you receive a skin cancer diagnosis, the next step is to identify its stage.
Staging is how doctors determine whether the cancer has spread to other parts of your body. Staging is common with melanoma and Merkel cell carcinoma, because these cancers are more likely to spread.
Typically, basal cell and squamous cell carcinomas dont involve staging. These skin cancers are easily treated and dont usually spread. However, your doctor may recommend staging for larger lesions.
Staging is based on the size of the growth and whether it has high-risk features. High-risk features include:
- larger than 2 millimeters thick
- spreads into the lower levels of the skin
- spreads into the space around a nerve
- appears on the lips or ears
- appears abnormal under a microscope
Heres a general breakdown of skin cancer stages:
- Stage 0. The cancer hasnt spread to surrounding areas of the skin.
- Stage 1. The cancer is 2 centimeters across or less, with no high-risk features.
- Stage 2. The cancer is more than 2 cm across and has a least two high-risk features.
- Stage 3. The cancer has spread to the bones in the face or nearby lymph nodes.
- Stage 4. The cancer has spread to the lymph nodes or internal organs.
Treatment Of Basal Cell Carcinoma
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Removal of the tumor
Doctors may remove the cancer in the office by scraping and burning it with an electric needle or by cutting it out. Doctors may destroy the cancer by using extreme cold .
Certain chemotherapy drugs may be applied to the skin. Photodynamic therapy , in which chemicals and a laser are applied to the skin, also may be used. Occasionally, radiation therapy is used.
A technique called Mohs microscopically controlled surgery may be required for some basal cell carcinomas that are large or regrow or occur in certain areas, such as around the nose and eyes.
People whose cancer has spread to nearby tissues or spread to other parts of the body and who are not candidates for surgery or radiation therapy may be given the drug vismodegib or sonidegib taken by mouth.
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When To Seek Out Medical Attention After A Bad Sunburn
Although mild and even moderate sunburns can usually be treated on your own, you may need to seek out a medical professional if your symptoms get worse. There are a few signs after getting a burn that you need to see a doctor, such as the following:
- Feeling faint or weak
- Experiencing nausea and vomiting
- Blisters that are large or infected
If you experience these symptoms, go to an emergency department or medical clinic promptly. Without treatment, your symptoms may get worse.
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Spread Through The Lymphatic System
The lymphatic system is a network of tubes and glands in the body that filters body fluid and fights infection. It also traps damaged or harmful cells such as cancer cells.
Cancer cells can go into the small lymph vessels close to the primary tumour and travel into nearby lymph glands . In the lymph glands, the cancer cells might die. But some may survive and grow to form tumours in one or more lymph nodes. This is called lymph node spread.
This 2 minute video is about the lymphatic system.
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