Diagnosis & Treatment


Biopsy

Punch Biopsy – The doctor uses a special tool that rotates and cuts through layers of the skin to take a small sample.

Incisional and Excisional Biopsies – These biopsies remove a deeper skin sample, using a surgical knife to cut through the full thickness of skin. Incisional biopsies remove only a portion of the tumor. Excisional biopsies remove the entire tumor and are usually preferred when melanoma is suspected. 

Fine Needle Aspiration Biopsy – Fine Needle Aspiration (FNA) biopsies use a thin needle to remove a very small tissue sample from a tumor. This test is not used on a suspected melanoma, but on a large lymph node near a melanoma to find if the melanoma has spread (metastasized). A CAT scan is sometimes used to guide the needle into a tumor in an internal organ when the doctor suspects that melanoma has spread to that organ.

Sentinel Lymph Node Biopsy – This a procedure that helps find out if cancer has spread by locating which lymph node or nodes are draining the tumor area. These nodes are then removed and examined under a microscope to see if they have trapped any melanoma cells. The presence of melanoma cells in the lookout “sentinel” lymph node automatically classifies a melanoma as stage III.

Microscopic Examination – Skin tissue samples are sent to a pathologist for examination under a microscope. The results of these confirm the presence or absence of melanoma.


Stages of Melanoma

Stage 1:
Tumors that are 0-2.0 mm without ulceration or 0-1.0 with ulceration. Surgical excision is highly effective (90% cure rate for lesions < 1 mm).

Stage II:
Tumors that are 1.01 mm or greater and are ulcerated or 2.01 mm or more and are non-ulcerated.

Stage III (Regional Disease)
The primary tumor has satellite or in-transit metastasis or has spread to regional lymph nodes.

Stage IV (distant Metastasis)
Tumor has spread beyond the lymph nodes, usually to the lung (70-80%), liver (54-77%) or the brain (36-54%).


Surgery

Surgery is the best way to remove early melanomas. Later stages usually require more extensive treatment.

Simple Excision – Thin melanomas are surgically removed, along with a small amount of non-cancerous skin at the edges. This procedure can result in a complete cure of most patients with thin melanomas (stage 1).

Re-excision (Wide Local Excision) – After a biopsy has confirmed the diagnosis of melanoma, the site will be excised again. This procedure removes more tissue around the primary melanoma for examination to confirm that no cancer cells remain. If a large area of tissue is removed, a skin graft may be done at the same time.

Therapeutic Lymph Node Dissection – This procedure is performed when the lymph nodes nearest the melanoma feels abnormally large or hard. The lymph nodes are surgically removed and examined microscopically for evidence of melanoma cells. Your doctor may perform a procedure called Lymph Node Mapping. This procedure is used when there are several lymph node basins that drain from one primary tumor site, allowing the doctor to identify the nodes that are suspected of containing melanoma cells.

Mohs Surgery (Named after Dr. Frederic Mohs) – Using a microscope to examine the tissue, the surgeon excises the growth layer by layer until only healthy tissue remains. Each section is microscopically reviewed by the Mohs surgeon (who is trained in the interpretation of horizontally oriented pathology specimens). In cases where microscopic examination reveals tumor in one or more of the subdivided specimens, a corresponding mark is drawn on the Mohs map. The concept of orienting the tissue specimens horizontally, which allows for review of 100 percent of the surgical margin, is unique and is what sets Mohs micrographic surgery apart from all other skin cancer removal techniques.


Treatment

Radiation Therapy
Radiation therapy (radiotherapy) uses high-energy rays to stop cancer cells from growing. This procedure affects only the cells in the treated area. Radiotherapy is not used to treat the original site of the melanoma, but is most commonly used to relieve some of the symptoms of melanoma, but is most commonly used to relieve some of the symptoms of melanoma that has spread to the brain, bones or other parts of the body.

Biological Therapy (immunotherapy)
This type of treatment uses the body’s natural immune system to fight cancer. T-lymphocytes or T-cells, cancer-fighting immune system cells which occur naturally in the human body, are “trained” in the lab to recognize their tumor targets and injected into the patient. 

Chemotherapy
Chemotherapy is used to treat melanoma when cancer cells have spread to distant organs. Anticancer drugs are injected into a vein (intravenously) or given by mouth or a combination of both. Because chemotherapy affects normal cells along with cancer cells, side effects are common. Chemotherapy is usually administered on an outpatient basis. Treatment is usually administered in cycles of 3-5 days.

Biochemotherapy
Biochemotherapy incorporates biological therapy with chemotherapy. 

Managing Nausea & Loss of Appetite

  • Ask your doctor to order anti-nausea medication
  • Get at least 8 hours of sleep each night
  • Light exercise can stimulate the appetite
  • Rinsing your mouth can eliminate bad taste in your mouth

Managing Fatigue

  • Take short naps or breaks throughout the day
  • Light exercise such as walking can lessen the feeling of fatigue
  • Take up activities that are less strenuous, such as watching television