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What if a suspicious spot or mole is found?
See your dermatologist or family doctor as soon as possible to have the lesion examined. A skin biopsy under local anesthesia may be needed. A pathologist or tissue specialist will then analyze the sample.
What if melanoma is found?
If the biopsy confirms a melanoma, further surgery will be needed to remove a safety margin around the site. This serves to remove the cancer cells that may still exist at the site of the melanoma. Since most melanomas are found at an early stage, there is a 90% survival rate.
In some cases, Mohs micrographic surgery may be used to excise the melanoma, for example if the lesion is on the face. This is a longer surgical procedure as the tissue is checked for cancer during the operation. In this way healthy skin is preserved as much as possible.
*A cancer diagnosis can sometimes cause a significant emotional shock. Patients are advised to express their concerns about the melanoma diagnosis. Some patients may occasionally need help from professional counsellors.
Factors affecting treatment
The main factor in determining treatment is the depth of the melanoma in the skin, as measured by the pathologist (Breslow index). The deeper the cancer, the more likely it has spread and the more likely it will recur.
Melanomas less than 1 mm thick spread very rarely. Removal of the melanoma and a surrounding margin of skin completes treatment. Other factors affecting treatment include location of the melanoma and ulceration.
If you need further tests:
If the melanoma is thicker (usually more than 1 mm), a sentinel lymph-node biopsy is often suggested to test for cancer cells in the lymph node closest to the melanoma. The results will help your doctors determine the stage of your melanoma and the treatment needed. Blood tests, a CT scan or a nuclear-medicine examination called a PET-scan may be used on occasion. (See Stages of melanoma.) |
Types of melanoma
There are four main types of melanoma.
Superficial spreading melanoma accounts for about 70% of cases of this disease. These lesions tend to grow outwards, so watch for spots or moles that are spreading.
Nodular melanoma is a more dangerous form of melanoma since it grows quickly downward into the skin. It often appears on areas not usually exposed to the sun, such as the face, chest and back. It appears as a raised area and is usually very dark, but is sometimes reddish.
Lentigo maligna melanoma appears on the parts of the body constantly exposed to direct sunlight. It is frequently found among older people. It appears as an often fairly wide, flat brown patch marked by several hues of brown and black.
Acral lentiginous melanoma is the most common melanoma in dark-skinned people and those of Asian descent. It appears on the soles of feet, palms of hands and under toenails and fingernails. |
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Stages of melanoma
There are five stages of melanoma based on the thickness and other features of the tumour. These stages provide an important guide to treatment, indicate the risk of recurrence, and determine if other tests are needed. *In Canada, most melanomas are found at an early stage
(See the description below for in situ or Stage 0 when the tumour is still limited to the outer layer of the skin and unlikely to have spread.)
Stage 0
Melanoma in situ is the most frequent stage, when the tumour is limited to the outer layer of the skin and has not spread. Surgery is done to remove the melanoma and the surrounding skin, which completes the treatment. The prognosis is excellent.
Stage 1
These are very early melanomas, less than 2 mm thick. Depending on the severity, a sentinel lymph-node biopsy is sometimes suggested. Treatment also includes a local re-excision.
Stage 2
The tumour is thicker than 2 mm. A sentinel lymph-node biopsy is usually suggested. After surgery there is a moderate risk of recurrence or spread to another part of the body because of the depth of the tumour.
Stage 3
The melanoma has spread to nearby lymph nodes. These will have to be removed.
Stage 4
This is an advanced stage of melanoma. The cancer has spread to another part of the body such as the lungs, liver, brain or abdomen. This situation is rare.
For Stages 3 and 4, post-surgical treatment focuses on preventing the cancer from coming back and on killing the cancer cells in the body. The following treatments, used alone or in combination, may be prescribed.
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