Malignant Melanoma is a canceraous growth arising in a mole. If caught early the outlook is excellent. Recognising early signs is important as the treatment is mostly surgical.

WHAT IS MALIGNANT MELANOMA?

Malignant melanoma is a form of skin cancer. Sometimes melanoma occurs in a long standing mole which begins to change.  In other cases it may arise in skin where there was no mole present. There are approximately 6000 new cases diagnosed in the UK each year and this figure is rising.  

WHAT SHOULD YOU LOOK FOR?

Any change in a mole may be significant and should be discussed with your doctor.  Things to be particularly aware of are a change in shape, size or edge to a mole.  A change in colour can also be important, such as becoming darker, paler or varied.  Itching, bleeding and a persistent ulcer or scab are significant and should be examined by your doctor.  

IS IT REFERRED TO AS ANYTHING ELSE?

Although it might just be referred to as simply “skin cancer”, it is very different from other types of skin cancer.  Basal Cell Carcinoma and Squamous Cell Carcinoma are also called skin cancer but they are quite different from melanoma in that they have a much lower risk of spread.  

WHAT CAUSES MALIGNANT MELANOMA?

Sunburn is one of the main risk factors associated with melanoma but there are many others.  These include a family history of melanoma, fair skin and blue eyes, skin that burns easily, having lots of moles and/or freckles and a previous history of skin cancer.  

WHAT TREATMENT IS AVAILABLE FOR MALIGNANT MELANOMA?

In many cases the melanoma can be removed by minor surgery to cut away the tumour. The tumour will be removed with a rim of normal skin. The thicker the tumour, the more normal tissue that has to be taken around the edge.  This can often be performed under a local anaesthetic.  This means that the patient will be awake during the operation but the area will be made numb with an injection into the skin.  Most patients will be able to go home the same day. Depending on the size and location of the melanoma, a skin graft or other plastic surgery techniques may be needed.  In complicated cases a general anaesthetic would be used (i.e. the patient would be asleep) and this might require a short stay in hospital. Radiotherapy and chemotherapy are not routinely used for melanoma; however there are occasions when chemotherapy is considered.  In addition there are many ongoing studies into alternative treatments including a vaccine against melanoma.  New treatment options may become available in the future. Once melanoma has spread to other areas of the body, the chance of complete cure is significantly reduced and treatment is aimed at controlling the spread of the disease and treating symptoms.

WHAT ARE THE BENEFITS OF TREATMENT?

Unlike the other main forms of skin cancer (BCC and SCC), malignant melanoma has a high chance of malignant spread (i.e. spread to other organs of the body) and can therefore be potentially life threatening.  Surgical removal of a melanoma is the best form of treatment and can be potentially curative.  If a melanoma can be removed at an early stage, when it is relatively thin and before it has had a chance to spread, the chance of cure is higher.  

WHAT ARE THE COMPLICATIONS OF SURGERY?

The surgery will leave a scar.  There may be problems with wound healing, particularly in smokers, and infection of the wound can also occur.  If a skin graft is used, in some cases the skin graft dies (fails to take) and a further operation may be needed. Once the tumour has been removed it will be sent to the laboratory for close investigation under the microscope to make sure that it has been completely removed.  In some cases some of the tumour is left behind and another operation will be needed.  In other cases, although the entire tumour is removed, the tumour may be thicker than first thought and it is advisable to have a second operation to take a little bit more of the normal skin around the area.  

WHAT WILL HAPPEN AFTER TREATMENT?

You may need to take some painkillers after the effect of the anaesthetic has worn off. You will be given instructions on how to look after the wound.  It must be kept clean and dry.  You will need an appointment to have any stitches removed after 5 to 10 days either with your own GP or in the hospital outpatients department.  If dissolvable stitches are used they will disappear on their own and will not need removal.  You will be told exactly what to do and given a follow-up appointment.  You will be given the result of the laboratory investigations, usually at your next appointment.  You will be followed up at regular intervals for between 5 and 10 years to make sure that there is no recurrence, new melanomas or evidence of spread.  

WHEN CAN NORMAL ACTIVITIES BE RESUMED?

If the wound is on the head or neck, you should avoid bending down for at least 24 hours after the operation.  It may be advisable to have someone else to drive you home after the surgery.  You should keep the wound dry until the stitches have been removed and you will be given instructions about washing the area.  You should avoid the use of makeup until the wound has healed. You should always apply sun-block when out in the sun.