Surgery for Melanoma Less Than 1 Millimeter Thick
A thin melanoma–one that is less than 1 millimeter thick (stage 1A or 1B)–is usually treated with a wide local excision of the skin, in which the surgeon cuts out the melanoma and an area around it. The amount of skin that is removed and the degree of scarring relate to the size of the lesion or mole. Generally, these patients do not need adjuvant therapy such as chemotherapy, immunotherapy, or radiation therapy.
Depending on the size of the melanoma, the local excision may be an in- or outpatient procedure, usually with local anesthesia. The area may require stitches, and recovery can last a few weeks. The severity of the scar depends on the size, depth and location of the melanoma.
Surgery for Melanoma More Than 1 Millimeter Thick
Melanomas 1 millimeter or more in thickness are considered somewhat more serious than thin melanomas because they are more likely to spread to other areas of the body. For larger melanomas, in addition to a wide local excision, a surgeon will often do a lymph node biopsy to check whether the cancer cells have spread. In a lymph node biopsy, lymph nodes in the area of the cancer are surgically removed to see whether they contain cancer. Your surgeon may opt to do a sentinel lymph node biopsy, in which only the closest lymph node to the tumor is removed to check for cancer. If the lymph node closest to the tumor is cancer free, then the other lymph nodes do not need to be checked or removed.
Metastatic Melanoma (Stage IV)
At this stage, melanoma has spread into distant skin or lymph nodes or other organs such as the lungs, liver, or brain. Surgeons do not usually operate to remove these metastases. Even if large metastases can be removed, there are very likely smaller ones in other places that would be missed. However, treatment may still be able to improve symptoms and extend life. A doctor may recommend systemwide chemotherapy or immunotherapy to improve a patient’s quality of life.
A number of immunotherapy medications may be injected into the skin to treat skin cancers. The most commonly used is interferon-alpha. Interferon works by stimulating the body’s immune response to destroy skin cancer tissue. The tumor progressively shrinks. The destruction is relatively specific, and healthy tissue is usually spared. Redness, inflammation, and flulike symptoms may occur as part of the immune system response. It may take a series of injections, spaced several months apart, to eradicate a larger skin cancer.
Interferon can also be used for people whose melanoma has spread beyond the original cancer site to one or more lymph nodes, in order to prevent or delay melanoma recurrences. In this case, it is given for a year to decrease the risk that melanoma will return. For the first four weeks, a high dose of interferon is administered intravenously five days a week; for the rest of the year, a lower dose is injected under the skin three days a week, usually by the patient.
If a large area of skin must be removed during surgery, a skin graft may be done to reduce scarring. In a skin graft, the surgeon first numbs and then removes a patch of healthy skin from another part of the body, such as the upper thigh, and then uses it to replace the skin that is removed to cover the wound from surgery. This is done at the same time as the skin cancer surgery. The surgeon first numbs and then removes a patch of healthy skin from another part of the body. The patch is then used to cover the area where skin cancer was removed. If you have a skin graft, you may have to take special care of the area until it heals.
Radiation therapy may be used to treat all types of skin cancers–basal and squamous cell, and melanoma.
Radiation therapy uses high-energy photons (X-rays) to destroy tissue. It targets the tumor site as well as a surrounding margin of skin. Shields are custom made for each patient to protect as much of the nontargeted tissue as possible.
Radiation therapy can be adjusted to be superficial or deeply penetrating, which means it can treat a variety of tumors. Properly performed, radiation therapy can achieve high cure rates with little or no scarring. Patients who have multiple lesions in one region of skin may have radiation therapy instead of surgery. Radiation therapy may be combined with chemotherapy, in chemoradiation, for advanced tumors.
Melanoma patients have a high risk of developing new melanomas. Some also are at risk of a recurrence of the original melanoma in nearby skin or in other parts of the body. The chance of recurrence is greater for patients whose melanoma was thick or had spread to nearby tissue than for patients with very thin melanomas. Family members of people with melanoma should also have regular checks for melanoma.
To increase the chance of detecting a new or recurrent melanoma as early as possible, patients should follow their doctor’s schedule for regular checkups. Follow-up care for those who have a high risk of recurrence may include X-rays, blood tests, and scans of the chest, liver, bones, and brain.
It is especially important for patients who have dysplastic nevi (atypical moles) and a family history of melanoma to have frequent checkups. People with melanoma also should monitor their own skin carefully for changes. See the Testing section for more information.