Malignant Melanoma
What is a malignant melanoma?
A malignant melanoma is a skin cancer that arises from the cells within the skin that produce pigment.
What are the different types of malignant melanoma?
The different types of malignant melanoma are:
Lentigo maligna – a melanoma that arises in a pre-existing freckled or pigmented area.
Superficial spreading melanoma – a melanoma that arises as a new lesion and tends to spread horizontally within the skin.
Nodular melanoma – a melanoma that usually arises in a pre-existing mole and tends to spread both horizontally and vertically, i.e. downwards into the deeper tissues
Acryl lentiginous melanoma – a melanoma that arises in the skin of the palm or soles of the feet.
What are the changes in a skin lesion that I should look out for?
If you have a skin lesion, which is pigmented (darker than the surrounding skin), which increases rapidly in size, itches, bleeds, has an irregular border, has irregular (variegated) pigmentation or which loses its pigment and becomes pale then you should consult a plastic surgeon who has a special interest in the management of skin cancer.
How is the diagnosis of a malignant melanoma made?
The diagnosis of a malignant melanoma is usually clinical as a Plastic Surgeon with expertise in the condition will usually be able to tell from examination of a lesion under magnification whether there has been a suspicious change. Sometimes it is not possible to make this diagnosis clinically and therefore an excision biopsy, i.e. a complete removal of the mole or pigmented lesion with a narrow margin, will be required to make the histological diagnosis.
What happens if the excision biopsy is positive for malignant melanoma?
The treatment of a malignant melanoma depends upon the thickness of the melanoma. This thickness is measured in millimetres from the surface of the skin. Melanomas are classified as thin, intermediate and thick on the basis of the pathology report.
For most melanomas a wider excision with a safety margin to include a suitable area depending upon the thickness of the melanoma is required.
In some cases it is possible to close the wound directly resulting in a straight line scar. In other situations either a skin flap or a skin graft may be required to close the lesion.
Will I require any further investigations?
Depending upon the thickness of the melanoma I may request blood tests and a scan of the chest and abdomen as a base line study to ensure that there is no disease elsewhere in the body.
Can malignant melanomas spread to any other parts of the body?
In some cases cells from the original melanoma can travel and present as lumps in the skin surrounding the original lesion, in the lymph nodes that drain the area or they can travel in the blood stream and spread to the lungs and the liver.
How will I be followed up following the original excision?
Depending upon the thickness of the melanoma regular appointments either on a monthly or bimonthly basis will be scheduled with me for a clinical examination to ensure that there has been no spread. In addition you may also need annual blood tests and scans for a follow up and comparison with the tests that were conducted at the time of initial presentation.
Where can I find more information about malignant melanoma?
A sensible site to visit is www.cancerbackup.org.uk. This site is written by doctors, nurses and patients and presents the available information on skin cancer in a readable and non-sensationalised format. It will provide you with good background information as to why certain treatments or tests are being carried out and what you can expect during the course of your treatment. You may also find the following link useful: http://www.skincancer.org/skin-cancer-information/melanoma?gclid=CPCA2-ik1bECFTMhtAodFzEAhQ.
