II melanoma is defined as someone who has initially undergone a to make the diagnosis of melanoma. The will have found that it has not spread elsewhere in the body, and it will have been found to be between 1 and 2mm thick with ulceration, or thicker than 2mm with or without ulceration. You will then be offered a and you may also be offered a . This will determine whether the melanoma cells have spread to your lymph nodes. If the melanoma has spread to the nodes this would make your melanoma III and your doctor may recommend a further operation to remove more lymph nodes.
After surgery, forII melanoma you are unlikely to be offered , which is the name for treatment after surgery for cancer to prevent it from coming back.
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 and a radiologist (x-ray/scan doctor) and possibly some other types of support staff. This is because there is currently very little evidence to support a benefit from which has a risk of .
The following information should be used as part of a discussion with your healthcare professional 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. There may also be variation in access to some of these due to regional service variation and limited clinical evidence.
is where the abnormal mole or area of skin will be removed (‘excised’), and sent to a laboratory for testing. The excision is a relatively simple operation performed under . This is essential to make the diagnosis of melanoma. The analysis of the typically takes two weeks and therefore there will be a short wait after the before the diagnosis is known.
As the majority ofII melanomas are only on the upper layers of skin, almost all are cured by surgery and do not reduce length of life.
Depending on the size of your melanoma, this procedure is relatively minor and can be performed under. There may be some scarring. If the area of skin being removed is large, the doctor may take an initial smaller to make the diagnosis and then perform the wider excision at a later date.
Like all surgery, excision of melanoma carries risks, including wound infection, scar formation, bleeding and nerve damage.
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Once the melanoma has been removed byand undergone analysis you may be offered a in order to try to ensure that cancerous cells are not still present in the skin surrounding the melanoma. This surgical procedure, sometimes performed under general anaesthetic, will remove a further area of skin around the first scar site. The size of the further excision will be subject to a discussion with your healthcare professional and recommendations will be made depending on the thickness of the melanoma. If a is to be undertaken, this will be done at the same time as the .
is undertaken in order to prevent the cancer returning by seeking to ensure all the melanoma cells in the area are removed. However, there remains debate about the recommended margins, in terms of the width of surrounding normal skin that should be removed and how this impacts on the chances of the melanoma returning. Trials are currently under way to look into appropriate margins. Your healthcare professional will discuss this with you before making a decision.
is usually a small operation. However, the doctor 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 is likely to leave a scar. The extent of the scar will depend on the amount of skin removed, the surgical technique and the location of the excision. The scar will usually be larger or more extensive than the original excision scar. Some can be more complex than others if the procedure requires a flap or .
Like all surgery, excision of melanoma carries risks, including poor scarring, infection, bleeding, pain and numbness. More specificwould be explained by your surgeon according to the site involved.
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will take place at the same time as your . This is an optional investigation done under general anaesthetic to test whether the melanoma has spread to the (s) nearby. The surgeon will use a dye and a low dose of radioactivity picked up on a scan before surgery. This scan will identify the first draining (s). The (s) will be removed for analysis. The likely position of the sentinel (s) may have been mapped out in advance by a special test. If, after the analysis, there are no cancer cells in the sentinel (s), you won’t need any further surgery. However, if the melanoma is found to have spread to this node(s), your doctor will discuss further treatment with you, including further consideration of removal.
There are differences of opinion about whether or not doing ais useful. Your health care professional will be able to discuss the pros and cons of this option.
is an investigation method rather than a treatment and it does not extend length of life in itself.
The surgeon will have to make an incision to reach thearea, so you will have stitches and a dressing. You may be able to return home the same day as the procedure, but general anaesthesia can affect your co-ordination, memory and concentration, so you’ll need to avoid driving or drinking alcohol for 24-48 hours afterwards. Recovery times vary and will depend on the size of your wound, but it will probably take a week or two.
might include pain, bruising and swelling in the area where you’ve had the procedure, a blue stain in your skin in that area, and blue or green coloured urine (from the dye used to identify the node). There is also a risk of an allergic reaction to the dye, an infection in the wound and a build-up of fluid in the area or in your arms or legs but these risks are low. 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.
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If your melanoma was diagnosed atII you will be followed up once you have been treated. This will ensure the melanoma has not returned or spread, identify new melanomas or other potential skin cancers and to offer support and education around the disease. Following consultation with your healthcare professional(s) a follow-up plan should be put in place. The details of your plan should be agreed by you and your healthcare professional(s). However, most patients are seen every three to six months for five years.
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 appropriate support. For example, if you are struggling with household chores as a result of 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 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 17 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.