A melanoma is a malignant skin cancer involving the melanocytes – the cells that produce the skin’s pigmentation. It can present as a new mole or an existing mole that is changing – in size, colour, shape or sensation. Changes may be on the border or the pigmentation within the mole, perhaps involving several shades of brown. There may be inflammation surrounding the mole or it may be getting larger.
It may bleed or ooze and become crusted.
There are different types of melanoma – some are nodular, while others grow more vertically. Some have a superficial spreading pattern and grow horizontally. These include lentigo maligna and melanoma-in-situ, which occupy the top layer of skin and, if removed early, are not in danger of migrating.
Some don’t have pigmentation and these are more difficult to diagnose. They may present as a pink nodule or pink lesion. Cancer is suspected if such lesions are not healing and are growing rapidly.
Melanoma are primarily caused by exposure to ultraviolet light and fair skinned people are particularly at risk. The UV rays may be from the sun, by sunbathing or simply through long and frequent exposure to the light by working outside, or through the use of sunbeds and tanning devices. Sunburn is considered to be a danger, particularly in childhood, and the melanoma may not develop until some years later.
A suspected melanoma is diagnosed with an excisional biopsy, which involves removing the area with a margin of 2 mm of normal skin. This then goes off for histological analysis to confirm the diagnosis.
If the diagnosis is confirmed, a wide local excision is undertaken, to remove a larger margin around the original mole. This treatment can often be performed under local anaesthetic on an outpatient basis.
Treatments may include further surgery, radiotherapy, chemotherapy and/or bio-immunotherapy.
There have been quite a few developments in treatments for advanced melanoma of late, involving dermatologists, plastic surgeons and oncologists, with resultant improvement in outcomes for patients.
At discharge from treatment for melanoma, patients are supplied with an information pack regarding sun protection and skin self-examination. The vitamin D level of patients will already have been tested and the protective benefits of this vitamin will have been discussed.
On discharge, patients are advised to return to their GP if they notice a new or changing lesion. They are also given contact details for the skin cancer nurses so that any queries or concerns can be addressed.