Source: Cancer Resource Room

What is Melanoma?
Melanoma is a skin cancer that starts in cells called melanocytes. These cells make melanin, the pigment that gives color to our skin. When these color-producing cells become cancer, they make abnormal colored spots.

What are the symptoms of Melanoma?
Signs of melanoma are spots that are flat or rounded and sometimes both. They have irregular edges or borders that look as if they are spreading out to cover the normal skin nearby. Melanomas grow unevenly, getting wider and often developing areas of different colors, including black, brown, red and even a bluish shade.

Melanoma usually starts in skin that has been damaged by the sun. The sun damage may have happened years ago. The injury to the pigment cells (melanocytes) builds up over the years until cancer cells result. As the cancer cells multiply, they also make the pigment (or color) they normally do. Many color-producing cells in one place cause a dark spot. Because these cancer cells grow and divide without control, the dark spot gets bigger. It grows unevenly so the edges don’t look smooth and sharp.

Melanoma is a dangerous cancer disease because it spreads so easily from the original small spot in the skin to the lymph nodes nearby and then to other parts of the body. Even very small melanomas can spread its’ cancer cells to nearby lymph nodes. Most of the time the original spot in the skin can be removed easily and completely. But the melanoma cells may have already spread through the lymph system to other parts of the body. The spread or metastasis of melanoma is what makes this disease so dangerous.

How is melanoma diagnosed?
Recognizing a spot in the skin as abnormal.

Doing a biopsy for melanoma
A biopsy takes some or all of the abnormal spot of skin. A pathologist then looks at the sample under a microscope to see if it is cancer. Many melanomas are small enough to cut out completely. If it is large, then a small piece at the edge of the spot can be taken out (this is called a “punch biopsy”). In melanoma, a biopsy is used to make a diagnosis and to find out how deep the spot goes under the skin.

How is a biopsy done?
There are two ways to biopsy a spot suspected of being melanoma. If the spot is small, the entire spot is removed (or excised) with a little extra normal skin all around it (called a margin). If the spot is large, a sample can be done as a “punch” biopsy. A punch biopsy uses a small tube with a sharp end to take a core of tissue from part of the spot. Both types of biopsies are done in a doctor’s office. Novocain is used to numb the skin so the biopsy does not hurt. A pathologist who specializes in skin diseases should look at the biopsy to make the diagnosis.

What does a biopsy show?
The biopsy of a suspected melanoma should show three things—the diagnosis, how far into the skin the cancer cells go, and whether or not the whole melanoma has been removed.

• Diagnosis—the pathologist who looks at the biopsy tissue can tell what kind of cells are in it. Looking at the tissue with a microscope is the only way to be certain that a spot is melanoma.
• Depth of abnormal cells— measuring the thickness of a melanoma is important in making treatment decisions. Two systems to measure depth are used:
  
  • Breslow thickness (or depth) measures in millimeters how thick a melanoma is from its top surface to where it ends beneath the skin.
  • Clark’s level looks at how deeply the melanoma invades the different types of skin layers
    Margin—this is the edge all around the tissue that was removed by surgery. The tissue edges (or margin) must be completely normal. If any abnormal cells are at or close to the margin, more tissue needs to be removed.
  • To see an illustration of these systems>>>

What other skin cancer tests are needed?
Like any cancer, melanoma can spread to other places in the body. Some tests that check for cancer spread are blood tests, x-rays, CT, MRI, bone scans, and lymph node biopsies.

The first place melanoma spreads is to the nearest lymph nodes. Lymph nodes can be checked in three ways.

• examining the patient for enlarged nodes—if any nodes are big enough to feel, a biopsy is done to check for cancer cells. A node biopsy can be done by removing the lymph node or by pulling some cells out of the node through a thin needle. Both can be done in a doctor’s office using local anesthetic (novocain) in the skin over the lymph node.
• sentinel node biopsy—this is a way to locate a lymph node that cannot be felt but that may have cancer cells in it. Sentinel node biopsy is done by injecting a combination of a blue dye and some mildly radioactive fluid into the skin where the melanoma was removed. The lymph that drains that area will carry the dye to the nearby lymph nodes. It gets trapped in the nodes long enough for a surgeon to remove one or two nodes for the pathologist to look at. If there are no melanoma cells in the sentinel node, then it is unlikely that the cancer has spread anywhere else.
• node dissection—when a melanoma has spread to the nearby lymph nodes, it is useful to remove as many of them as possible. This helps remove more of the cancer. Also, it can predict how likely it is that the melanoma has spread to other parts of the body.

Other cancer tests
If melanoma has spread to several nearby lymph nodes, then checking other parts of the body for possible spread (or metastasis) may be necessary. Some tests that may be done include:

• Regular blood tests - can measure levels of liver or bone enzymes. If the enzyme levels are not normal, it may mean that cancer has spread to the bones or liver.
• Chest X-ray - can test for spread to the lungs
• CT and MRI scans - can find metastasis to the liver, lungs, brain and internal lymph nodes
• Bone scan - can show disease spread to the bones

Does every melanoma patient need all these tests?
No. Fortunately, many melanomas are discovered and removed when they are small and not deep in the skin. These melanomas can usually be cured by removing them with a normal margin (or rim) of tissue. Patients with thin, completely removed melanoma do not usually need all the tests discussed above.

Support & Education Programs

We know that being diagnosed with cancer can be stressful for you and your family. We offer a variety of cancer support services to help patients and families gain the support and information they will need to meet the challenges ahead.

To find the next Melanoma Support Group and other free education and support workshops plus wellness services offered this month, please view the HOPES calendar.

Read the most recent SUPPORT publication, a resource written by patients and families for patients and families >>>