I melanoma is the thinnest form of the disease with no spread to other parts of the body including the lymph nodes. I melanoma can be further subdivided into IA and IB.
IA means all of the following:
IB can be categorised as either:
Your case will be discussed by a Local Skin Cancer Multi-Disciplinary Team (MDT), which includes a(skin doctor), a plastic surgeon, an (cancer doctor), a specialist nurse, a pathologist (who reviews the ) and a radiologist (x-ray/scan doctor) and possibly some other types of support staff.
After the removal of aIA melanoma you should have an initial follow-up appointment, where you will be shown what to look out for in future and to address any questions or concerns that you may have. You will also have further appointments for the doctors to examine you.
If your doctor thinks you have a . If this is ‘negative’ your melanoma will be now be considered as IA which has a better . If your is positive, your melanoma will be considered III and you would be eligible for . These treatments will be discussed with you by an .IB , you may be offered a
If you don’t have a, your IB melanoma will usually be seen every three months for three years and then every six months for another five years.
I melanoma treatment is straightforward and usually involves removal of the skin around the melanoma to fully remove it. The type of surgery is usually one involving a direct closure with a linear or straight line scar. At sensitive sites, such as the face or hands, different options for reconstruction would be explained to you in order to enable you to complete the required treatment that suits your individual needs. For example, a local flap (nearby spare skin in moved around) or (a shaving of skin or a piece of skin is used as a dressing) may be a better option in some sites.
If your melanoma was diagnosed atI you are unlikely to have further recurrence of your disease and almost everyone is cured by their surgery, provided you have had sufficient tissue from around the melanoma removed.
The following information should be used as part of a discussion with your medical team about the most appropriate treatment for your melanoma. Patients should also be aware that they may not be suitable for all the diagnostic interventions and treatments outlined below.
Local excision is where the abnormal mole or area of skin (and a small amount of normal skin around the area) will be removed (‘excised’) and sent to a laboratory for testing. The excision is a relatively simple operation performed under local anaesthetic by a dermatologist or plastic surgeon. A pathologist will look at this tissue under a microscope and make a diagnosis. The analysis of the biopsy typically takes two weeks and therefore there will be a short wait after the biopsy before the diagnosis is known.
Like all surgery, excision of melanoma carries risks, including poor scarring/cosmetic appearance, wound infection, scar opening up, bleeding and numbness. As this is usually a small procedure, these risks are often minimal.
More information on local excision can be found here.
If theafter your shows that you have melanoma, you will need to return to hospital to have a further operation. This is called a and is generally done under a , but may be done under a general anaesthetic. The doctor removes a large area of healthy skin and tissue from around where the melanoma was. How much tissue you have removed depends on:
In the latest guidelines, the National Institute for Health and Care Excellence (NICE) recommend that:
is usually a small operation. However, the surgeon will use stitches to close up the skin that has been removed and as a result the skin may feel tight at first but this should subside as it stretches. The surgery will leave a scar and its severity will depend on the amount of skin removed, the surgical technique and the location of the excision. The scar will be larger than the scar from the original excision.
Sometimes your surgeon needs to remove a large area of skin. This may not close directly, so an additional procedure is required to close the wound. Generally, your surgeon will try and close the area with a local flap, as it is more robust and has a better cosmetic appearance. Here, spare skin next to your wound is moved to close the wound and because it is ‘spare’ the area it came from can also be closed. If a flap is not possible then awill be required. The is taken from somewhere else on your body and used like a dressing. The graft sticks like a slow setting glue and needs to be looked after whilst it is sticking. Infection, bleeding or injury to the area can all affect how the glue sticks.
Like all surgery,of melanoma carries risks, including poor scarring, infection, bleeding, pain and numbness. More specific would be explained by your surgeon according to where the skin was removed.
More information on here.can be found
The most common place that melanoma skin cancer spreads to is the nearby lymph nodes. If your melanoma is deeper than 1mm (IB to IIC) or if there are additional risk factors, your specialist should offer you a . The lymph nodes are arranged like a bunch of grapes, the allows your doctor to identify the ‘grape’ or node within the bunch and then remove it for analysis. This node is the most likely to be affected by your melanoma. The procedure has two parts; the first occurs in the nuclear medicine department where a safe radioactive dye is injected around your melanoma or scar where your melanoma was, the dye travels in lymphatic channels to where the lymph nodes are, several marks are then drawn on the skin. The second part takes place in the operating theatre, when you are asleep. A blue dye is now injected around the melanoma or scar where your melanoma was and the combination of the radioactivity and the blue staining allows your surgeon to identify the ‘grape(s)’ in the bunch of lymph nodes. This node(s) is removed at the same time as you have the of tissue around your melanoma. The blue dye has been used for over 20 years and is accepted practice worldwide. A few patients may have a bad reaction to the blue dye (anaphylaxis) – similar to the reaction some people have to bee stings or nut allergies, and they would need to stay in hospital at least overnight. Generally, this procedure is completed in one day.
The Sentinel Node, if positive, removes the node(s) which will contain small numbers of cells. This prevents these cells from growing and spreading to other lymph nodes in the area. If you have a positive , you will be considered for adjuvant therapy which may improve their survival. This is the main reason why patients choose to have this procedure in addition to a .
A positive node is found in about 20% (1 in 5) who are offered the procedure. If you are one of the 20% who have a melanoma deposit in your, but do not have a sentinel node , then at some time during your follow up, either you or your doctor will feel a lump, where the lymph nodes are. The few cells that would have been found had you had a sentinel node , will have grown such that they form a lump which you can feel. For the 80% of people who do not have any melanoma in their (s) and would have had a negative sentinel node , then the majority will not detect this lump. It is important to know that even if your sentinel node is negative, in a small number or patients (~ 3-4%) the melanoma will come back in a different . That is why even if you have a negative sentinel node, you are likely to be followed up for 5 years.
Most people are able to go home on the same day of their surgery, but general anaesthesia an affect your co-ordination and concentration, so you’ll need to avoid driving or drinking alcohol for 24-48 hours afterwards. Simple pain relief is usually all that is needed (paracetamol). Most people will need around a week off work, although this will vary depending on the area your melanoma was removed from and the type of reconstruction required to repair the wound. You are likely to need to either see your local practice nurse or return to the dressing clinic in the hospital where you had your surgery for the first dressing change. Any further dressing changes will be discussed with you then.
The wounds will take several weeks to settle and at least 9 months or so for the scars to soften and settle. The final cosmetic outcome will depend upon what type of reconstruction has been needed for your surgery, how you heal, whether there were any problems during the healing phase, other medical conditions you have and if you are a smoker. Generally, most people are not troubled by their scars.
might include pain, bruising and swelling in the area where you’ve had the procedure. The blue dye will make your urine look blue or green for the next couple of days. This is harmless. There is also a risk of an allergic reaction to the dye, an infection in the wound but these risks are low. There will be a collection of fluid in the area (seoma) but this generally settles, there could be a longer-term collection of fluid in your arms or legs ( ), but this is rare when only one or two lymph nodes are removed. As with any operation, there is also risk of nerve injury and adverse reaction to anaesthesia. Your surgeon will be able to discuss the risks of the procedure in your particular situation.
More information on here.can be found
Many view taking part in aas a very positive experience. Some of the benefits include:
Often studies are randomised, so you will not know whether you are receiving the new or the standard treatment. Some research has shown that taking part in a trial improves long-term survival, even if you do not have the drug/procedure being tested. The reasons for this are not clear, however it has been suggested that hospitals which undertake medical research provide better treatment.
You also need to consider that new treatments are not always better than standard treatments. The new drug or treatment might not work for you and sometimes there are unexpected.
Many trials compare new treatments with standard treatments, you may be selected to receive either the new treatment or the standard treatment. So, by agreeing to be in a trial, it does not necessarily mean you will receive the new drug being tested.
You may be eligible to take part in a trial. They have strict criteria for joining them to make sure that the results can be relied upon by comparing like with like, and not all treatment centres are involved in trials. Yourshould know what is possible, but sometimes you may need to ask specifically about clinical trials.
You might want to ask:
You may also be asked to take part in research studies, for example into your wellbeing, which may involve taking part in interviews and surveys.
Remember, if you are suitable, it is your decision whether or not to join a.
If your melanoma was diagnosed at stage I, you are unlikely to have further recurrence once you have been treated. Although this is the case for most patients, those who have been treated for stage I melanoma are followed up to ensure the melanoma has not returned or spread, to identify new melanomas or other potential skin cancers and to offer support and education around the disease. Following consultation with your medical team, a follow-up plan should be put in place.
If you have any concerns or worries please contact our Helpline, which is manned by skin cancer nurses from 1pm – 2pm and 7pm – 9pm Monday to Friday (except bank holidays) and 7pm – 9pm Sunday.
There are lots of sources of support and advice for people with melanoma and other types of cancer. If you speak to your professional about your needs – whether they be emotional, social, financial or practical – they can refer you to an appropriate key worker who can help you to find the support you need. For example, if you are struggling with household chores because you have been affected by your melanoma (e.g. when you’re recovering from an operation), social services might pay for someone to visit to help you out.
The biggest cancer charities in the UK are Cancer Research UK and Macmillan Cancer Support. Both have lots of information on their websites about coping with cancer, along with online communities where you can discuss your treatment with other people. Macmillan also has a phone line and provides face-to-face and financial support to people with cancer and their families.
Melanoma Focus is a national charity dedicated to providing a comprehensive source of information for the public and professionals, as well as lobbying, supporting education and funding research about melanoma. Melanoma Focus also has a helpline, manned by skin cancer nurses, which can be found here.
Melanoma UK, The Myfanwy Townsend Research Fund and the Karen Clifford Skin Cancer Charity (Skcin) are also charities that provide support to melanoma patients, as well as fundraising and raising awareness of melanoma among the public and politicians.
With centres based in the grounds of 21 major NHS cancer hospitals across the UK, Maggie’s provides free practical, emotional and social support to people with cancer, as well as their families and friends. Centres without Maggie’s will have other support options in place which your clinical team will be able to tell you about.