Melanoma Treatment

What are the symptoms of melanoma?

The first symptom of melanoma is often a change in a mole, or the appearance of a new mole that has ABCD characteristics. These ABCD rules can help you tell a normal mole from cancer. The ABCDE rules are:

  • Asymmetry. One half of the mole does not match the other half.

  • Border irregularity. The edges of the mole are ragged or irregular.

  • Color. The mole has different colors in it. It may be tan, brown, black, red, or other colors. Or it may have areas that appear to have lost color.

  • Diameter. The mole is bigger than 6 millimeters across, about the size of a pencil eraser. But some melanomas can be smaller.

  • Evolving. A mole changes in size, shape, or color.

Melanoma Diagnosis

Diagnosing melanoma starts with checking out a mole or other mark on your skin. Your health care provider will examine your skin with the ABCDE rules in mind. This means looking at:

  • Asymmetry. One half of the mole does not match the other half.

  • Border irregularity. The edges of the mole are ragged or irregular.

  • Color. The mole has different colors in it. It may be tan, brown, black, red, or other colors. Or it may have areas that appear to have lost color.

  • Diameter. The mole is bigger than 6 millimeters across, about the size of a pencil eraser. But some melanomas can be smaller.

  • Evolving. A mole changes in size, shape, or color.

Your health care provider will ask you about the mole. Tell him or her:

  • When you first noticed it

  • If it hurts or itches

  • If it oozes fluid or bleeds, or gets crusty

  • If it’s changed in size, color, or shape

Make sure to tell your health care provider if you’ve had skin cancer in the past. Also note whether anyone in your family has had skin cancer.

Getting a biopsy

A biopsy is a sample of tissue that’s taken to be checked in a lab. Your health care provider will likely take a biopsy of any mole or other skin mark that may look like cancer.

Types of biopsies

The different types of biopsies include the following:

  • Excisional biopsy. This type of biopsy is often used when a wider or deeper piece of the skin is needed. It’s done when a melanoma is suspected. The entire mole and part of the surrounding skin is removed. First, a local anesthetic is used to numb the area. Using a surgical knife (scalpel), a full thickness wedge of skin is removed. The wound is closed with surgical thread (sutures), staples, steri-strips, or surgical glue. This depends on the size and location of the incision.

  • Incisional biopsy. This procedure is the same as an excisional biopsy. But only part of the mole or mark is removed.

  • Punch biopsy. This type uses a special tool to take a deep sample of skin. The tool removes a short cylinder of tissue, like an apple core. First, a local anesthetic is used to numb the area. The punch tool is turned on the surface of the skin until it cuts through all the layers of skin. This includes the dermis, epidermis, and the most superficial parts of the subcutis (fat). The biopsy sample is removed and the edges of the wound are then stitched together.

  • Shave biopsy. This type of biopsy removes the top layers of skin. They are shaved off with a scalpel. Shave biopsies are done with a local anesthetic. This method may be used on a mole if the chance if melanoma is very low. This method is not usually used if melanoma is suspected.

Lab tests of your biopsy sample

A biopsy sample is sent to a lab, where a doctor called a pathologist looks at them under a microscope. He or she may do other tests on them to see if they contain melanoma cells.

If melanoma is found, the pathologist will look at certain features of the melanoma. These include the thickness of the melanoma and the portion of cells that are actively dividing (mitotic rate). These can help determine the extent (stage) of the melanoma. The stage of melanoma helps determine treatment options.

The pathologist might also do other tests to look for certain gene changes within the melanoma cells that could affect treatment options. For example, about half of all melanomas have changes in the BRAF gene that help the cells grow. Certain medicines can help treat melanomas that have this change. But these medicines are not likely to help treat melanomas without this gene change. Testing the cells before treatment is important.

Getting your biopsy results

Your biopsy results will likely be ready in a few days to a week or so. Your health care provider will notify you of the results. He or she will talk with you about other tests that may be needed if melanoma is found.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

The doctor is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your doctor may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Types of treatment

Treatments for melanoma are local or systemic:

  • Local treatments. These remove, destroy, or control the cancer cells in one area. Surgery and radiation therapy are local treatments.

  • Systemic treatments. These are used to destroy or control cancer cells in the entire body. Chemotherapy, targeted therapy, and biological therapy are systemic treatments.

You may have just one treatment, or a combination of treatments.

Goals of different treatments

Each type of treatments has its own goal. Below is a list of treatments and their goals:

  • Surgery. The goal of surgery is to remove the melanoma, while leaving as much of the nearby skin as intact as possible.

  • Radiation therapy. The goal of radiation is to destroy cancer cells. It may be used after surgery to try to kill any cancer cells that are left. It may also be used to help treat melanoma that has come back after initial treatment or has spread to other parts of the body. Radiation therapy uses high energy X-rays or other types of radiation.

  • Chemotherapy. The goal of chemotherapy is to destroy cancer cells directly to shrink tumors that can’t be removed by surgery. Or, it may be used to kill cells that have spread to other areas of the body (metastatic melanoma). Chemotherapy is done with medications.

  • Biological therapy. The goal of biological therapy is to shrink advanced melanoma tumors. This type of therapy is done with medicines. The medicines use chemicals that affect the immune system. It is also called immunotherapy, antibody therapy, or vaccine therapy. The medicine uses your body’s immune defense to attack the cancer cells. Common medicines for this include interferon and interleukin-2. These may also be given along with chemotherapy for stage IV melanomas. Medicines called immune checkpoint inhibitors can also boost the body's immune response. These include pembrolizumab and ipilimumab.

  • Targeted therapy. The goal of targeted therapy is to shrink advanced melanoma tumors. This type of therapy is done with medicines. The medicines target specific parts of melanoma cells. For example, medicines called BRAF inhibitors target cells with a change in the BRAF gene. This gene is found in about half of all melanomas. BRAF inhibitors include vemurafenib and dabrafenib.

Clinical trials for new treatments

Researchers are always finding new ways to treat cancer. These new methods are tested in clinical trials. Talk with your doctor to find out if there are any clinical trials you should consider.

Talking with your doctor

At first, thinking about treatment options may seem overwhelming. Talk with your doctors, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your doctor before making a decision.

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