What is melanoma?
Melanoma is a cancer that often starts in the skin, in an existing or new mole. However, melanoma can also occur in almost any part of the body. The incidence of melanoma has been rising and according to the American Cancer Society, there were about 60,000 new cases of melanoma in this country in 2005.
What are the symptoms of the cancer?
When melanoma starts in the skin, one might notice a mole that appears asymmetric, with irregular borders and different colors, or it may have grown or changed in some way. Sometimes people describe a mole that started bleeding or itching. Some patients may present with a lump or nodule as a symptom of the cancer.
In those with more advanced disease, symptoms of the cancer vary depending on the location of the melanoma. In advanced disease, one may notice discomfort or feeling more tired than usual.
What causes melanoma?
The exact cause of melanoma is unknown. However, there are factors that put one at higher risk of developing melanoma. Some of those risk factors include: fair skin, blonde/red hair, history of blistering sunburns, outdoor jobs, those with multiple moles, and those with a family history of melanoma.
How is melanoma diagnosed?
Melanoma is diagnosed with a biopsy of the suspicious tissue. A biopsy is a procedure that involves using a needle or surgical procedure to remove the skin lesion, or to obtain a sample of the involved tissue. The tissue is then taken to a lab and is studied under a microscope to establish the diagnosis.
If the biopsy does reveal melanoma, then a wide excision surgery may be necessary to completely excise (remove) the involved area. If the melanoma extends deeper than 1 mm or if there are other characteristics that increase the risk for the melanoma to recur or spread, then a sentinel lymph node biopsy may also be performed. The sentinel lymph node is the lymph node or nodes most likely affected by the melanoma due to the location of the nodes in relation to the melanoma.
A sentinel lymph node biopsy is performed by a surgeon and is often done at the time of the wide excision surgery. The surgeon will inject a small dose of a low-level radioactive tracer into the area around the melanoma. A blue dye is also injected to help locate the sentinel node during surgery.
Next, the surgeon will wait for the tracer and the dye to travel from the tumor region to the sentinel lymph node or nodes, just as cancer cells might spread. Then, the surgeon will scan the area with an electric, hand-held gamma ray counter (called a Geiger counter) to detect the radioactive tracer.
The gamma ray counter will make a sound revealing the exact location of the sentinel nodes. Once the area has been identified, the surgeon will make an incision and remove the sentinel nodes for a pathologist to examine under a microscope to check it for melanoma. If the sentinel nodes do contain melanoma, then another surgery will likely be needed to remove additional lymph nodes in that area.
If there is a large melanoma, positive lymph nodes, and/or symptoms, your health care provider will probably order tests to see if the melanoma may have spread to other parts of the body. The following are examples of tests that may be ordered:
- Blood tests
- Chest X-ray
- Positron emission tomography (PET scan)
- Computed tomography (CT or CAT scan)
- Magnetic resonance imaging (MRI)
What is melanoma staging?
The melanoma staging system puts together the size of the tumor (Breslow’s or thickness), the number of lymph nodes involved, and whether the melanoma has spread to other areas of the body. The stage helps determine what kind of treatment a patient should receive and also provides information on survival rates.
For example, those with Stage I melanoma have a high survival rate.
The melanoma is relatively thin and appears to be localized in the skin. At this stage, it has not spread to the lymph nodes or organs.
The melanoma may be thicker than in Stage I. It is localized in the skin and has not been found in the lymph nodes or organs.
The melanoma has spread to lymph nodes near the affected skin area. For example, if there is the melanoma is located on a leg, then the lymph nodes in the groin may be involved. At this stage, there is no spread to any organs.
The melanoma has spread beyond the original area to other organs, such as the liver or lung.
What are the treatment options?
The treatment for melanoma depends on the stage of melanoma and the patient’s general health. Clinical trials at the Cleveland Clinic Cancer Institute provide innovative treatment options.
For Stage I melanoma , surgery may be the only necessary treatment. However, it is usually recommended that people who fall in this category, and in the other stages, practice sun precautions. Sun precautions include using sun screen, wearing brimmed hats, avoiding the sun from 10 a.m. to 2 p.m., checking their skin for suspicious moles, and seeing a dermatologist, oncologist, and/or their family physician on a regular basis.
Those with Stage II or III melanoma may receive additional treatment with either immunotherapy such as interferon alpha 2b or on a clinical trial.
Those with Stage IV melanoma may receive chemotherapy, radiation, surgery, treatment on a clinical trial, and/or palliative care or hospice.
The Melanoma Clinic, Taussig Cancer Center
In our multidisciplinary Melanoma Clinic, patients are able to see both a medical oncologist and a surgical oncologist on the same day, in the same building. Research nurses, social workers, dermatologists, radiation oncologists, plastic surgeons, and pathologists are also involved.
Research in the Taussig Cancer Center
The Cleveland Clinic Taussig Cancer Institute is actively conducting research on new therapeutic approaches to melanoma. At the Center for Hematology and Oncology Molecular Therapeutics (CHOMT), located in the Taussig Cancer Institute, investigators are striving to develop new and effective targeted therapies, including immune- and biologic-based treatments that will improve both the quality and length of life for patients.
These treatments are being evaluated in clinical trials and are some of the most promising treatment options available.