August 30, 2015
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Melanoma (cont.)

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How is melanoma diagnosed?

Most doctors diagnose melanoma by examining the spot causing concern and doing a biopsy. A skin biopsy refers to removing all or part of the skin spot under local anesthesia and sending the specimen to a pathologist for analysis.

The biopsy report may show any of the following:

  • A totally benign condition requiring no further treatment, such as a regular mole
  • An atypical mole which, depending on the judgment of the doctor and the pathologist, may need a conservative removal (taking off a little bit of normal skin all around just to make sure that the spot is completely out).
  • A thin melanoma requiring surgery
  • A thicker melanoma requires more extensive surgery or extra tests in which the lymph nodes are examined. Removing lymph nodes causes physical problems even when there is no tumor present and, for that reason, is not recommended for thinner melanomas.

Some doctors are skilled in a clinical technique called epiluminescence microscopy (also called dermatoscopy or dermoscopy). They may use a variety of instruments to evaluate the pigment and blood vessel pattern of a mole without having to remove it. Sometimes the findings support the diagnosis of possible melanoma, and at other times, the findings are reassuring that the spot is nothing to worry about. The gold standard for a conclusive diagnosis, however, remains a skin biopsy.

What is the treatment for melanoma?

In general, melanoma is treated by surgery alone. Doctors have learned that surgery does not need to be as extensive as was thought years ago. When treating many early melanomas, for instance, surgeons only remove 1 centimeter (less than ½ inch) of the normal tissue around the melanoma. Deeper and more advanced cancers may need more extensive surgery.

Depending on various considerations (tumor thickness, body location, age, etc.), the removal of nearby lymph nodes may be recommended. For advanced disease, such as when the melanoma has spread to other parts of the body, treatments like immunotherapy or chemotherapy are sometimes recommended. Many of these treatments are still experimental and, for that reason, their use may be limited to patients willing to participate in a research study.

How do doctors determine the prognosis (outlook) of a melanoma?

The most useful criterion for determining prognosis is tumor thickness. Tumor thickness is measured in fractions of millimeters and is called the Breslow's depth. A related prognostic measure is the Clark's level, which describes how many skin layers the melanoma penetrates. The lower the Clark's level and the smaller the Breslow's depth, the better the prognosis. Any spread to lymph nodes or other body locations dramatically worsens the prognosis.

Thin melanomas, those measuring less than 1 millimeter, have excellent cure rates. The thicker the melanoma, the less optimistic the prognosis. Early diagnosis and treatment are essential.

Medically Reviewed by a Doctor on 4/16/2015

Source: MedicineNet.com
http://www.medicinenet.com/melanoma/article.htm

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