Melanoma

Melanoma: Frequently Asked Questions

Here are some frequently asked questions related to melanoma.

Q: How can I tell if a skin growth is melanoma? Is there any special appearance that I should watch for?

A: Be alert for growths that ooze fluid or blood, crust or clot over, and then ooze or bleed again. A sore that doesn’t heal after a week or two may be cancerous. Be on the lookout for moles or skin spots that are:

• Bigger from edge to edge than a pencil eraser
• Have uneven or ragged edges
• Show combinations of more than one color especially red, white and blue/black
• Have a different appearance on one half than on the other

Those are warning signs of possible melanoma. Check with the doctor if they occur.

Q: My wife was treated for melanoma. The dermatologist said it was so small and thin that the entire tumor was removed with thebiopsy. He thinks that no other tests or treatment are needed. Yet I’ve heard that melanoma is very dangerous because it spreads. Should my wife have more tests?

A: Melanoma detected in an early stage often can be cured with an excisional biopsy. The biopsy removes all the cancer cells before the melanoma has had a chance to spread to other organs. If your wife had Stage I melanoma, the doctor seems to be following national guidelines on melanoma care if he removed a margin of normal tissue (e.g. 5 mm for in-situ melanoma). These guidelines state that extra tests or treatment are not needed for very early melanoma.

Q: How can I tell if the treatment planned by local doctors is right for me? I have advanced melanoma that has spread to mylymph nodes. Naturally, I want to make sure that the treatment kills the cancer cells before they spread further.

A: Get a second opinion. Have a melanoma specialist from another institution look over your treatment plan and offer suggestions. A lot of patients think their doctor will be insulted or angry if they ask for a second opinion. That’s rarely the case, however. A second opinion can benefit the patient and the doctors. Your doctor can refer you to a specialist for a second opinion. Names of melanoma specialists also are available from medical schools, local medical societies, and other sources.

Q: My friend read about a melanoma test that can show whether melanoma has spread to lymph nodes, and can pick out the exact nodes that have cancer cells. Should I ask the doctor about this test?

A: The test is a sentinel lymph node biopsy. Many doctors feel that it can help in more accurately deciding the stage of a melanoma. It usually begins with lymph node “mapping,” which identifies the exact lymph node basin where fluid from the tumor site drains. The fluid may carry cancer cells. Doctors biopsy the first node in the basin, remove it and have it examined for cancer cells. If positive the remaining nodes are removed. If the sentinel node is negative, it avoids the need to remove presumably normal lymph nodes.

Q: What’s lymphedema? My doctor said it might be a problem after she removes the lymph nodes in my underarm. They’ve found melanoma cells there.

A: Lymphedema is a backup of lymph, the clear fluid that flows from tissues in the body to lymph nodes. From the nodes, lymph drains into the bloodstream. When all of the lymph nodes in the armpit are removed, lymph accumulates and may cause painful swelling and other problems in the arm. Lymphedema is a lot less serious than cancer, of course. Sometimes it can be avoided. Lymph node mapping and a sentinel lymph node biopsy, for instance, can reduce the number of nodes that must be removed. Ask your doctor whether these tests may help in your own case.

Q: How often should I return to the doctor for follow-up care after treatment for melanoma?

A: That depends on the stage of your melanoma and a lot of other individual factors. Doctors usually ask patients to return for a complete checkup every three months for the first two years after treatment. Each visit will probably include a complete skin examination, and a check for enlarged lymph nodes. Doctors may order a chest x-ray and scans of the lungs, brain, and other organs depending on symptoms.

Q: I’ve been referred to a dermatologist by my family doctor. She thinks that a growth on my back may be melanoma. What questions should I ask the dermatologist?

A: It’s important to ask questions and work with the doctor in planning treatment and follow-up care. Start the dialogue by asking about the melanoma’s stage and whether to be concerned that the cancer has spread. Some other important questions include:

• What tests should be done, if any, to see if the melanoma has spread?
• What is the usual treatment?
• Will treatment cure the cancer?
• How often will I come back for follow-up care?
• What can I do to reduce my risk of getting skin cancer again?

Q: My mother had melanoma. I’m worried that I may get it, too, especially because I have a lot of moles on my skin. What kind of medical checkups are recommended?

A: Melanoma does run in families. If your parents had melanoma, your own risk may be higher than normal – especially if you have many moles of a certain kind. Your primary care doctor or dermatologist should do a total skin examination at each routine physical examination. That involves inspecting every inch of your skin, including the genital region and the area between the buttocks. If the doctor spots suspicious growths, you’ll probably get a referral to a dermatologist. Once you know that your skin is normal, get in the habit of doing a skin self-examination to watch for new growths or changes in existing growths.

Q: What is the best way of preventing melanoma?

A: Scientists don’t know for certain what causes melanoma. Many believe that too much exposure to the sun is the number-one cause. Try to avoid two kinds of exposure:

• Constant day-to-day exposure that occurs in people who work outdoors or enjoy outdoor sports or leisure activities.
• Less frequent but more intense exposure that causes sunburn. Vacationers, skiers, and others who get intense sun exposure a few times a year may be at high risk for malignant melanoma, the most serious kind of skin cancer.

When you are in the sun, wear clothing that shields the skin. A broad-brimmed hat is ideal in the summer. Be sure to use a “broad-spectrum”sunscreen that protects again both kinds of ultraviolet (UV) light, UVA and UVB.

Q: If melanoma occurs mainly in people over age 50, why is it important for children to avoid getting too much sun?

A: Childhood sun exposure may set the stage for adult skin cancer. The average person gets about 80 percent of his or her total lifetime sun exposure by age 18. Most severe sunburns also occur during childhood and adolescence. A single severe sunburn in childhood may increase an individual’s risk of skin cancer.

Q: Can malignant melanoma occur anywhere else on the body?

A: Although most pigment-producing cells are in the skin, some melanocytes occur in other parts of the body. These cells can also become malignant. Melanoma that begins in the eye is called ocular melanoma. Although the incidence is very rare, melanoma also can begin in the gastrointestinal tract, lymph nodes, brain, and other areas of the body.