What To Ask Your Doctor About Stage Iv Melanoma
When your doctor tells you that you have Stage IV melanoma, it can be frightening and overwhelming. But it is important to use the time with all of your doctors to learn as much about your cancer as you can. Your doctors will provide you important information about your diagnosis, prognosis, and treatment options.
It is often helpful to bring a friend or family member with you to your doctor appointments. This person can lend moral support, ask questions, and take notes.
The following questions are those you may want to ask your doctors. Some of the questions are for your medical oncologist, some are for your surgical oncologist, and some for your dermatologist. Remember, it is ALWAYS okay to ask your doctor to repeat or clarify something s/he has said so that you can better understand it. You may find it helpful to print out these questions and bring them with you to your next appointment.
There Are Different Types Of Cancer That Start In The Skin
There are two main forms of skin cancer: melanoma and nonmelanoma.
Melanoma is a rare form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in mucous membranes . This PDQ summary is about cutaneous melanoma and melanoma that affects the mucous membranes.
The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body.
Precancerous Conditions Of The Skin
Actinic keratosis is a precancerous condition of the skin. Precancerous conditions of the skin are changes to the skin cells that make them more likely to develop into cancer. Actinic keratosis is not yet cancer. But if it isnt treated, it may develop into a type of non-melanoma skin cancer called squamous cell carcinoma. Actinic keratosis is also called solar keratosis.
Actinic keratosis most often develops on areas exposed to the sun, such as the face, ears, neck, bald scalp, arms and backs of hands.
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What Should You Tell The Patient And The Family About Prognosis
The prognosis of primary melanoma is well defined by a set of staging procedures and large database reviews by the AJCC with over 18,000 patients.
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Based on T stage one can be assured of a very low risk of recurrence and death if disease is T1a.
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Ulceration upstages each lesion.
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Ulceration of the primary melanoma with regional lymph node involvement represents a very poor prognostic situation.
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Presence of regional lymph node involvement is likely overall the most important prognostic factor for localized melanoma.
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Those patients with N1b, N2b, or N3 disease have a much worse prognosis, with those with N3 disease having a risk of recurrence as high as 85-90% in some cases.
The disease can recur in-transit between the primary and the regional lymph nodes. This occurs primarily in those patients with a deep primary that is ulcerated or a desmoplastic melanoma on the scalp or elsewhere. Local recurrence or in-transit disease carries an extremely poor prognosis and will likely recur beyond the region in time, but can remain limited to the region for long periods of time without distant metastases. Recurrence in regional lymph nodes has become less frequent due to the incidence of SLND, but still represents a site of potential involvement.
Systemic treatment treatment of disseminated disease
Until recently, options for systemic treatment of unresectable metastatic disease were very limited and in general clinical trials was recommended as standard therapy for most patients.
After Melanoma Has Been Diagnosed Tests May Be Done To Find Out If Cancer Cells Have Spread Within The Skin Or To Other Parts Of The Body
The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
For melanoma that is not likely to spread to other parts of the body or recur, more tests may not be needed. For melanoma that is likely to spread to other parts of the body or recur, the following tests and procedures may be done after surgery to remove the melanoma:
The results of these tests are viewed together with the results of the tumor biopsy to find out the stage of the melanoma.
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Comparing Metastatic Melanoma Cells In Lymph Versus Blood
Most studies of cancer cell metastasis in people have focused on cells circulating in the blood. Thats because its much easier to collect patient blood samples than it is to collect samples of lymph, the clear fluid that carries immune cells through vessels of the lymphatic system, Dr. Morrison said.
Dr. Morrisons team found that human melanoma cells injected into lymph nodes in the mice were more likely to form distant tumors than melanoma cells injected into blood.
To study the role of lymph in metastasis, lead investigator Jessalyn Ubellacker, Ph.D., a postdoctoral researcher in Dr. Morrisons lab, figured out how to collect melanoma cells from lymph in mice. This allowed the team to do the first side-by-side comparison of melanoma cells spreading through lymph and through blood in the same animal, Dr. Morrison said.
Next the team found that melanoma cells in lymph experienced less oxidative stress than melanoma cells in blood. That offered a potential explanation for why melanoma cells from lymph nodes were surviving better and better able to form a tumor, Dr. Morrison said.
Further experiments showed that melanoma cells in blood are vulnerable to ferroptosisa form of cell death that occurs when lipids damaged by oxidative stress build up in the outer membrane of a cell. By contrast, melanoma cells from lymph nodes were protected from ferroptosis.
Survival Statistics For Melanoma Skin Cancer
Survival statistics for melanoma skin cancer are general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival.
There are many different ways to measure and report cancer survival statistics. Your doctor can explain the statistics for melanoma skin cancer and what they mean to you.
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Enhancing Healthcare Team Outcomes
Skin cancers are frequently seen by primary care providers, nurse practitioners, internists, and pharmacists this is why an interprofessional team approach is needed. While many skin lesions are benign, it is important always to consider melanoma- as it is potentially deadly if the diagnosis gets missed. If there is suspicion of melanoma, the patient should obtain a referral to the dermatologist/oncologist and pathologist for further workup, irrespective of which of the other healthcare providers first became suspicious. Surgery includes wide local excision with sentinel lymph node biopsy, elective node dissection, or both. These surgical procedures are the definitive treatment for early-stage melanoma.
When performing the wide local excision, first consider the surgical margins. If the primary closure is not feasible, skin grafting or tissue transfers may be needed. Medical management is reserved for adjuvant therapy of patients with advanced melanoma here again, the pharmacist can monitor medications and consult with the dermatologist. Dermatology nursing staff will assist at all stages of case management, and provide patient counsel and monitor the condition, reporting to the treating clinician as necessary. For localized lesions, the prognosis is with surgery, but advanced melanoma has a grim prognosis, but the interprofessional team approach to care will optimize the patient’s prospects for a better outcome.
The Breslow Scale Of Melanoma Stages
This method takes into consideration the thickness of the melanoma and checks for how deep it had gone.
When a patient goes to get their melanoma removed, it will be sent to a laboratory for a check. The pathologist will examine the melanoma and measure its thickness. The small ruler that is used to measure the tumor is called a micrometer.
It is important for the tumor to be measured, as it helps understand the current stage of cancer and how deep it has gone. Doctors generally use a scale which is called the primary tumor thickness scale. This scale is also called Breslow thickness, which is where this method of staging gets its name from.
Breslow thickness scale checks in millimeters how much of the skin has been affected.
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What Are The Treatments For Metastatic Melanoma
Ideally, melanoma is diagnosed and treated surgically while it is still small and thin and before it has had the chance to metastasize. The prognosis and survivability of metastatic melanoma remain poor compared to other types of cancer. Metastatic melanoma is less responsive to radiation therapy and traditional forms of chemotherapy than other forms of cancer.
Immunotherapy in which the body’s own immune system is used to fight the tumor has been a focus of research for decades and immune system “stimulants” such as interferon-alpha and interleukin-2 have also been tried for many years.
A variety of newer medications target different points in the biologic pathways of melanoma growth and spread. The following are drugs currently in use, or being actively investigated. More should be available shortly.
- Inhibition of kinase enzymes needed in cell reproduction like MEK: cobimetinib , trametinib
- Target cell growth signals from abnormal BRAF genes: dabrafenib , vemurafenib , nivolumab
- Improve immune response to the tumor: pembrolizumab , ipilimumab
As monotherapy , these drugs have not been shown to dramatically improve survival even if they did improve disease-free time. The hope is that combinations of medications targeting more than one part of the melanoma growth and metastasis pathway will provide more encouraging results.
There Are Different Types Of Treatment For Patients With Melanoma
Different types of treatment are available for patients withmelanoma. Some treatments arestandard , and some are being tested inclinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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What Are The Survival Rates For Melanoma
Melanoma can be treated most effectively in its early stages when it is still confined to the top layer of the skin . The deeper a melanoma penetrates into the lower layers of the skin , the greater the risk that it could or has spread to nearby lymph nodes or other organs. In recent years, clinical breakthroughs have led to new treatments that continue to improve the prognosis for people with advanced melanoma.
What If Scenarios In The Treatment Of Melanoma
What if a patient presents with isolated cutaneous lesion which is dermal and has no clear connection to the epidermis?
These are difficult cases where we do not know if this is a primary and where we simply do not see the characteristic atypical cellular activity at the epidermal/dermal junction or a dermal metastases from another melanoma.
In this situation it is most favorable to the patient to treat him/her as if this is a primary melanoma and perform a sufficient wide excision and sentinel lymph node mapping if indicated by the depth. In this case patients may have the best chance for long-term survival.
What if a patient has history of melanoma 3 years ago and now presents with an asymptomatic lesion found on chest x-ray?
In this case, imaging should determine the presence of other metastases . If none are found, the pulmonary lesion should be resected. There is no need to attempt a biopsy, whether it is a metastatic lesion from melanoma or a primary lung cancer, surgery would be indicated.
Obviously this will be influenced by the actual appearance of the lesion. Infiltrative, cystic lesions or calcified lesions should lead to an evaluation for infection or chronic inflammatory disease. The extent of surgery can be determined intra-operatively when a frozen section if performed.
What if a patient presents with several nodules on the extremity proximal to his primary melanoma what are the options?
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Can Changing My Diet Help Prevent Melanoma
The American Cancer Society advocates eating a plant-based diet over an animal-based diet as part of a healthy plan to avoid all cancers. Growing evidence suggests that plants pack a powerful punch in any fight against cancer because they’re nutritious, cholesterol-free and fiber-rich.
Theres no doubt that a healthy diet can protect your immune system. Having a strong immune system is important to help your body fight disease. Some research has shown that a Mediterranean diet is a healthy choice that may help prevent the development of cancer. Talk to your healthcare provider about the role food plays in lowering your cancer risks.
Some skin and immune-system healthy foods to consider include:
- Daily tea drinking: The polyphenols in tea help strengthen your immune system. Green tea contains more polyphenols than black tea.
- High vegetable consumption: Eating carrots, cruciferous and leafy vegetables is linked to the prevention of cutaneous melanoma.
- Weekly fish intake: Study participants who ate fish weekly seemed to avoid developing the disease when compared to those who did not eat fish weekly.
What Is Superficial Spreading Melanoma
According to the medical literature, this is one of the most encountered types of melanoma in the general population. Superficial spreading melanoma is a type of skin cancer, in which the pigment cells or melanocytes are transformed into malignant cells. It often affects more males than females and it is characterized by the fact that the malignant cells tend to stay within the initial tissue . In many patients, the superficial spreading melanoma remains in the in-situ phase for a long period of time, even decades.
In the initial phase, the superficial spreading melanoma grows on the surface of the skin in an horizontal manner. This is also known as the radial growth phase, when the skin presents lesions that are expanding . This type of skin cancer presents an increased risk to become invasive the malignant skin cells can cross the border and breach into the other layers of the skin, including into the dermis . Such situations require aggressive treatments and the results are not always positive.
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What If The Skin Changes Are Rapid Or Dramatic
Guideline # 4: The more rapid and dramatic the change, the less serious the problem.
When changes such as pain, swelling, or even bleeding come on rapidly, within a day or two, they are likely to be caused by minor trauma, often a kind one doesn’t remember . If a spot changes rapidly and then goes back to the way it was within a couple of weeks, or falls off altogether, it is not likely to represent anything serious. Nevertheless, this would be a good time to say once again: Nobody can diagnose him- or herself. If one sees a spot that looks as though it is new or changing, show it to a doctor. If one see a spot that doesn’t look like one’s other spots, it should be evaluated.
Lymph Nodes As A Stopover On A Cancer Cells Journey
Movement of melanoma cells into lymph nodes is not necessarily an endpoint, but rather a stopover on the cells journey elsewhere, wrote Barbara Grüner, Ph.D., of University Hospital Essen in Germany, and Sarah-Maria Fendt, Ph.D., of the Leuven Center for Cancer Biology in Belgium, in .
These results provide a first step towards understanding the protective environment of lymph, Drs. Grüner and Fendt wrote. To what extent findings apply to tumor types other than melanoma, and to humans, remains to be determined. If the results are relevant to human disease, innovative ways must be found for them to have a therapeutic impact.
Dr. Morrisons team is already looking into existing drugs that might make cancer cells more vulnerable to ferroptosis and block the protective effects of lymph, he said. The idea would be to see if such a drug could be given early in the disease course of melanoma to prevent it from spreading.
If we can find a therapy that blocks disease progression in mice, then we would go into clinical trials to see if it works in humans, he added.
Dr. Salnikow said multiple approaches will likely be needed to prevent the spread of melanoma, because different biological factors may be important for metastasis in different people.
One of the interesting questions to answer is whether MCT1 is also helping to protect these melanoma cells metastasizing through lymph, and were doing those experiments now, Dr. Morrison said.
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The Prognosis For Melanoma And Treatments
what is the prognosis for melanoma In the early stages prognosis of melanoma is usually very good. Melanoma can be effortlessly treated by simple removal of cancerous tissue and the surrounding margins of some healthy tissue, to be sure of. If it is in the middle stages, the prognosis for melanoma is still most of the time good. Here surgery is rather more serious as it may even include the removing of the nearby lymph nodes.
what is the prognosis for melanoma Unfortunately, if skin cancer of Melanoma does reach stage four, the prognosis thereafter is not at all very good. Treatment options mostly in this stage include only medications that will give relief to the symptoms and the pain relief, and moreover, there may be several surgeries accompanied with medications for removing tumors caused by metastatic cancer spread, found in various parts of the body.
what is the prognosis for melanoma The prognosis for melanoma will also help you to do more research as well as help you in having a discussion about what treatment you want to opt for as well as its side effects and what further self-care is needed so that disease doesnt spread much and moreover, you are able to increase your immunity with proper food and nutritional diet along with the prescribed medications which can help with the relieving of symptoms.