What is a malignant melanoma?
Malignant Melanoma (MM) is the rarest but the most serious of all skin cancers. There has been a sharp rise in the numbers over the last decade and it accounts for around 7,000 new cases each year. Melanoma is a cancer of the melanocyte cells, which produce the brown pigmentation in your skin that forms freckles, moles, and your suntan. Melanocytes are found at the base of the epidermis (the top outer layer of your skin).
Malignant Melanomas appear in normal skin or in changing moles. Suspicious changes include an increase in size, change in shape, deepening in colour, itching, bleeding and surrounding inflammation. They can spread along the skin’s surface but they can also penetrate inwards into the deeper layers of the skin. This is when, if left untreated, they may spread to other areas of your body.
If any melanoma cells have broken away they can spread to your lymph glands (also called nodes). You have lymph glands all over your body. There are large groups of them in your neck, jaw, axilla (armpit), elbow creases, groin and behind your knees. If the melanoma has spread it will generally travel to the nearest group of nodes from the original site and if this happens you will need to have all the glands in that area removed. This is known as a “block dissection”.
What are the causes?
The cause of melanoma is not entirely understood but there is strong evidence to suggest that ultraviolet radiation caused by exposure to high intensity sunshine (causing the skin to burn) is a major factor. People with fair or red complexions are particularly at risk especially if they have been sunburnt during childhood and early adulthood. A small group of people may have a genetic predisposition to the development of melanoma and the use of sun beds is also thought to increase the risk of developing skin cancer.
How are they treated?
Treatment of malignant melanoma depends largely on the result of your biopsy, which will tell us how thick your melanoma is (the Breslow thickness). You will be given the results of your biopsy approximately 4 weeks afterwards in the outpatients department.
Following your biopsy you may need to have another operation called a “wider excision” this is where a margin of healthy tissue is removed from around biopsy scar. In some cases you will be asked to have other investigations to find out if there has already been any spread of your melanoma.
Follow up care
For thin melanomas you will need to be seen as an outpatient every 3 months for 1 year. For thicker melanomas follow up will be 3 monthly for three years and then 6 monthly for two years.
At your follow-up appointments your melanoma site will be examined for signs of recurrence and your lymph nodes will be examined for signs of enlargement. You will be shown what to look for in your melanoma site and how to examine your own lymph glands by your Consultant or the Skin Cancer Clinical Nurse Specialist.
It is important that you examine your skin regularly:
Check for any new lumps, check any moles that are enlarged, change colour, itch, bleed, or fail to heal.
Examine the original scar site and surrounding skin and be aware of any new changes and seek advice.
Taking Care in the Sun
- Stay in the shade between the hours of 11am and 3pm.
- Make sure you never burn.
- Avoid the use of sun beds.
- Always cover up. Wear light cool clothing of a tight weave, wide-brimmed hats and U.V. protective sunglasses, look for the CE or BS EN 1836:1997 mark these offer the highest protection.
- Take extra care of children as their skin is delicate. Very young babies should be kept out of strong direct sunshine.
- Use a sunscreen of factor 30 and above, according to your skin type, ensure the sunscreen has UVB and UVA protection. Look for the star rating ****or ***** on the label, the price is not important. Apply it 15-30 minutes before you go out and re-apply regularly; every 2-3 hours.
- Remember: Pass on the message to family and friends about protecting themselves from the sun and being aware of changes to moles on their skin.
Telephone numbers for follow up appointments:
- Dermatology 01752 439712
- Plastic Surgery 01752 439937/431184
- Oncology 01752 432336
Patient information leaflets
Other sources of information:
The Mustard Tree Macmillan Centre,
Monday – Friday (Drop in)
Tel 01752 430060
Macmillan Cancer Support
Freephone: 0808 808 0000
Marcs Line (Melanoma and Related Cancers of the Skin)
Tel: 01722 415071