Melanoma of the skin

Melanoma is an aggressive skin cancer that has the potential to spread to other parts of the body. Common warning signs of melanoma are a skin sore that doesn’t heal or a change in the colour, shape, texture, or surface of a mole. 

Diagnosis

Diagnosis is confirmed by biopsy of the skin lesion. In some instances when the melanoma has already spread, such as to a lymph node, a biopsy of the lymph node may be necessary.  

Once the melanoma diagnosis is confirmed, molecular testing maybe appropriate in certain cases to see if the melanoma contains mutations (cancer gene changes), such as BRAF or c-Kit. These mutations can assist with treatment planning.

With the diagnosis of melanoma that looks more aggressive under the microscope or if the sentinel procedure is positive (spreading to lymph nodes), the doctors will usually ask for a CT scan or PET-CT scan to confirm the stage of the melanoma.  

Treatment

Surgery

Stage 1 to 3 melanomas are treated primarily with removal of the melanoma. The removal requires a good margin (wide excision), and for melanoma >1mm in thickness, a sentinel procedure will be performed to track and examine the nodal spread. 

Targeted therapy

In 50% of melanoma patients, the melanoma may have the cancer gene: BRAF mutation. If the BRAF mutation is present, a BRAF inhibitor therapy (targeting BRAF mutation) is a highly-effective method (>90% successful) to treat melanoma in both the Stage 4 as well as Stage 3 settings (where in Stage 3, one year of therapy will reduce the risk of melanoma recurrence by half).

Immunotherapy

In the other 50% of melanoma patients, BRAF mutation is absent. In such case, immunotherapy would be needed. This form of therapy aims to correct the immune system to identify where the melanoma is in the body and directs the own immune system to kill the melanoma. Immunotherapy is effective in approximately 50% of Stage 4 melanoma patients. Once the killing of melanoma is successful, the control of cancer from the immune system could be lifelong.  

Immunotherapy can also be used in the Stage 2 or 3 settings to reduce the risk of melanoma recurrence (by approximately half).

Other forms of treatment

Chemotherapy, radiotherapy, and surgery for metastatic disease are being used less often, as targeted therapy and immunotherapy are far more effective nowadays.

Clinical trial participation can present opportunities for patients who are willing to seek newer forms of treatment in the research setting (such as combination immunotherapy which may increase the odds of immune correction to > 50%). 

Most oncologists in SA can give you guidance for clinical trial information.

Survivorship

Prevention

Sun/UV protection is the key to survivorship. Always protect yourself from the harmful sun by wearing appropriate clothing or by applying sunscreen. Avoid the high UV exposure times during the day, usually between 09:00 and 16:00, or minimise the time spent during these hours (don’t forget sunscreen). Avoid tanning beds. Start sun protection education from an early age as repeated sunburns or prolonged sun exposure over a lifetime is the major risk factor for the development of melanoma (and other skin cancers).

Familiarise yourself with your own skin by checking for pattern of moles, freckles, blemishes, and marks, so you can notice the new changes or new moles early. Any change in size, shape and colour should be noted and seen to by a doctor promptly. Examine all areas and use a mirror or ask a friend or family member to check for areas that are hard to see. Don’t forget your ears, scalp, hands, and feet (including the nails).

Visit a dermatologist

Dermatologists are skilled to detect any skin problems. They also have the right tools to spot suspicious lesions better. If you have many moles, mole mapping (taking pictures of moles over time) by a dermatologist will be the best way of monitoring changing moles.  

If you were diagnosed with sun-damaged related skin cancers (melanoma, basal cell carcinoma, and squamous cell carcinoma), a dermatologist visit is vital as the previous sun-damaged skin is highly unstable and you may develop another new skin cancer easily.

If you were diagnosed with melanoma in the past, always look around the scar as melanoma can come back and spread under the skin around the original scar area. Always check the regional nodal area of the original melanoma (ask your doctor to show you). 

Visit the dermatologist to monitor the skin, and when appropriate (usually from Stage 1B upwards), visit your oncologists to monitor the organs and ultrasound the lymph nodes regularly.