When one thinks of skin cancer, most often it is melanoma that comes to mind. Fortunately this is the least common of the big 3 skin cancers; with squamous cell and basal cell being 27x more common.
However, this cancer has made a name for itself not because of it’s prevalence but because of it’s danger. This cancer can spread to lymph nodes as well as to other organs with some frequency and therefore causes more death and morbidity in many fewer cases (It’s about 100x more lethal…).
Approximately 196,000 cases of melanoma will be diagnosed each year. Of these approximately one half are noninvasive/in situ lesions that can be easily treated surgically. The other 100,000 however are invasive. There are approximately 7500 deaths associated with invasive melanoma each year.
5-year survival for melanoma that is treated before spread to the lymph nodes is 99%. However if it is spread to lymph nodes that dropped to 66% and if there is distant spread it drops further to only 27%.
While melanoma is generally disease of Caucasians there is an incidence in both Hispanic and African-American individuals as well. This equates to 31 per 100,000 compared to 5 for 100,000 and 1 per 100,000.
Since skin cancer is far less common in individuals of color it is often diagnosed at later stages.
Fully 25% of melanomas in African-Americans already show spread to lymph nodes and 16% show distant spread to other organs at presentation.
Significant sunburns in childhood or adolescence does increase the risk of melanoma. Having 5 sunburns tween 15 and 20 increases melanoma by 80% and nonmelanoma by 68%.
It is believed that approximately 40,000 cases of skin cancer are attributed to tanning beds each year.
It is estimated that overall melanoma will affect 1 in 27 men and 1 in 41 women.
Additionally melanoma survivors have a 9 fold increase in developing another melanoma compared to the general population.
Early diagnosis is the best treatment; therefore, frequent screening and self examinations are the best bet. However, once you are diagnosed with a melanoma (or pre-melanoma) surgical treatments are undertaken.
Suspicious looking moles should be biopsied. Based upon pathology, additional treatments may be required.
Abnormal moles will be classified as either mildly, moderately or severely abnormal/dysplastic/atypical.
Lower grades just need excision. Higher grades get wide local excision (WLE). In this process a ring around the entire lesion is removed measuring 5mm. This obviously leads to pretty extensive resections.
Melanoma in situ, is indeed a melanoma, but has yet to invade through the skin. This lesion is highly unlikely to spread and is treated with wide local excision (WLE) also of 5mm.
Once melanoma is invasive there are many things that go into staging and treating it; the most important of which is depth of invasion. <1mm, 1-2mm, >2mm. The WLE is 10, 10-20 and 20mm. With 10 to 20 mm on all sides, this creates much larger excisions and therefore much larger and more complicated reconstructions.
Further with lesions over 1mm deep and select “thinner” lesions, a lymph node staging is performed by biopsy of the sentinel lymph nodes. This is an in hospital procedure under anesthesia, generally performed outpatient basis.
Further staging and imaging and other tests may be required and will be coordinated with oncology.
All surgical treatment is offered here with the exception of certain head and neck lymph node biopsies and some completion lymphadenectomies where all lymph nodes in an area are removed in more advanced melanomas.