|Cancer is a disease of the body’s cells. Our bodies are always making new cells: so we can grow, to replace worn-out cells, or to heal damaged cells after an injury. This process is controlled by certain genes. All cancers are caused by changes to these genes. Changes usually happen during our lifetime, although a small number of people inherit a changed gene from a parent. Normally, cells grow and multiply in an orderly way. However, changed genes can cause them to behave abnormally. They may grow into a lump. These lumps can be benign (not cancerous) or malignant (cancerous). Benign lumps do not spread to other parts of the body. A malignant lump (more commonly called a malignant tumour) is made up of cancer cells. When it first develops, this malignant tumour may be confined to its original site. If these cells are not treated, they may spread into surrounding tissue and to other parts of the body. When these cells reach a new site, they may continue to grow and form another tumour at that site. This is called a secondary cancer or metastasis.|
|For a cancer to grow bigger than
the head of a pin, it must grow
its own blood vessels. This is
|The skin has many important functions. It protects us from injury, cools us when we get too hot and prevents us from becoming dehydrated. The skin has two main layers. The top layer is called the epidermis.
This layer contains, among other things, melanocytes—cells that produce melanin, the substance that gives skin its colour. The layer underneath the epidermis is called the dermis. The dermis contains the roots of hairs, glands which make sweat and oil, blood and lymph vessels and nerves. top of page
|Anatomy of the skin|
|Like all body tissues, the skin is made of tiny ‘building blocks’ called cells. These cells can sometimes become cancerous, for example under the influence of ultraviolet (UV) radiation. The epidermis contains three different types of cells: squamous cells, basal cells and melanocytes. Skin cancers are named after the type of cell they start from. The three main types of skin cancer are basal cell cancer, squamous cell cancer and—the most serious skin cancer—melanoma. top of page|
|Melanoma develops from melanocytes (pigment cells). Melanoma usually occurs on parts of the body that have been sunburned. However, melanomas can sometimes start in parts of the skin or other parts of the body that have never been exposed to the sun. If detected early, most melanomas are curable. If they are not detected until later, they can become more serious. A melanoma may appear as a new spot on normal skin, or develop from an existing mole. Melanomas usually begin as a flat spot that changes in size or shape or colour over months. While they remain flat they are generally curable. They usually remain flat for six to 12 months. Later, melanomas become bigger, irregular in shape and often darker in colour. A less common type of melanoma (called nodular melanoma) is not flat, but is raised from the start. These melanomas are often pink or red, and grow quickly. Not all melanomas are dark or black in colour. top of page|
|Causes of Melanoma|
People can be at greater risk of melanoma if they have one or more of the following:
diagnosed with melanoma. Melanoma is diagnosed most often in older adults, but it also sometimes occurs in younger adults and occasionally in teenagers. It is rarely seen in children. top of page
The first sign of a melanoma is usually the appearance of a new spot or a change in an existing freckle or mole. The change may be in size, shape and/or colour and the change is normally noticed over months rather than days. A normal freckle or mole is usually small and has an even colour and a smooth edge.
or long term (12 month) change to help with the diagnosis of melanoma. top of page
Measures to Assess Melanoma
In Situ and Invasive
Your doctor will provide more information on the stage of your melanoma when discussing treatment. top of page
|Sentinel lymph node biopsy|
|In patients with tumours thicker than 1.0 mm, a sentinel lymph node biopsy may be used to assess whether or not there has been spread to regional lymph nodes (the most common site of spread). This procedure involves the injection of radioactive dye in the region of the melanoma in order to identify the lymph node that is receiving the first lymphatic drainage from the site of the melanoma (the “sentinel” node). Once identified, it is excised and examined for melanoma cells. Sentinel lymph node biopsy can be associated with certain, usually minor, complications and requires a general anaesthetic. The procedure provides more information about whether spread has occurred but does not improve the chance of cure. The risks and benefits are explained to patients and they are encouraged to make their own decision as to whether it is something they would like to procede with. top of page|
|If you have melanoma, your doctor may recommend other tests. This is generally if surgery is being planned or if there is evidence that the melanoma may have spread to other parts of the body. The tests include:
• blood tests: to check your general health
• scans: to see if the cancer has spread to other parts of your body. These may include ultrasound, a computerised tomography (CT) scan, a PET scan and/or a magnetic resonance imaging (MRI) scan. Not everybody needs these additional tests. top of page
Many years of treating cancer patients and testing different treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. Your doctor will advise you on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread, your general health, and what you want. Treatments for melanoma include surgery, radiotherapy and chemotherapy. Some new treatments are tested in clinical trials. You may have one of these treatments or a combination.
After the operation
Lymph node biopsy and dissection
When cancer can’t be cured
|Melanoma is most likely to be cured when the cancer is treated in its early stages. More than 85% of people with melanoma diagnosed 15 years ago are alive and well today with no sign of the disease. This percentage has grown steadily over the years with early detection and treatment, so more people can expect to be cured. Other factors can influence your prognosis. For example, melanomas on the arms or legs have a better prognosis than those on the trunk, head or neck. Overall, women seem to fare better than men, although it is unclear just why this is so. You will need to talk with your doctor about your own prognosis. Your medical history is unique, so you will need to discuss with someone who knows your medical history what you can expect and the treatment options that are best for you. top of page|
|Follow up - the risk of further Melanoma|
|Most people treated for early melanoma do not have further trouble with the disease. However, when there is a chance that the melanoma may have spread to other parts of your body, you will need regular check-ups. Your doctor will decide how often you will need check-ups: everyone is different. They will become less frequent if you have no further problems. At least a yearly examination by a doctor is recommended, as people who have had one melanoma are at increased risk of another in the future. top of page|
|Protect your skin|
After treatment for melanoma, it is important to avoid strong sunlight. The following steps are sensible guidelines for everyone. Whenever UV radiation levels reach 3* (moderate) and above, sun protection is required. At that level UV radiation is intense enough to damage the skin and contribute to the risk of skin cancer.
|Making decisions about treatment|
Sometimes it is hard to decide which is the right treatment for you. You may feel that everything is happening so fast that you do not have time to think things through. Waiting for test results and for treatment to begin can be very difficult. While some people feel they have too much information, others may feel that they do not have enough. You need to make sure that you know enough about your illness, the possible treatment and side effects to make your own decisions. If you are offered a choice of treatments, you will need to weigh up the good and bad points about each treatment. If only one type of treatment is recommended, ask your doctor to explain why other treatment choices have not been advised. Some people with advanced cancer will always choose treatment, even if it only offers a small chance of cure. Others want to make sure that the benefits of treatment outweigh any side effects. Still others will choose the treatment they think offers them the best quality of life. Some may choose not to have treatment except to have any symptoms managed to maintain the best possible quality of life.You may want to see your doctor a few times before making a final decision on treatment. It is often hard to take everything in, and you may need to ask the same questions more than once. You always have the right to find out what a suggested treatment means for you, and the right to accept or refuse it. top of page
|Talking with others|
|Once you have talked about treatment options with your doctor, you may want to talk them over with family or friends, with nursing staff, the hospital social worker or chaplain, or your own religious or spiritual adviser. Talking it over can help to sort out which course of action is right for you. You may be interested in looking for information about melanoma on the Internet. While there are some very good websites, you need to be aware that some websites provide wrong or biased information. top of page|
|The Role of Immunotherapy|
|Immunotherapy is the use of drugs which stimulate the body to fight infection. It is being researched as a possible future treatment in melanoma to stimulate the body’s normal cells to attack cancer cells. Clinical trials are testing the possible effectiveness of immunotherapy in treating melanoma. Your medical oncologist will be able to discuss these trials with you. top of page|
|Taking part in clinical trials|
|You may consider taking part in a clinical trial. Clinical trials are a vital part of the search to find better treatments for cancer. Doctors conduct clinical trials to test new or modified treatments and see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have resulted in improvements to cancer treatment. However, the decision to take part in a clinical trial is always yours. If you are considering taking part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for you. Before deciding whether or not to join the trial, you may wish to ask your doctor:
• Which treatments are being tested and why?
• Which tests are involved?
• What are the possible risks or side effects?
• How long will the trial last?
• Will I need to go into hospital for treatment?
• What will I do if any problems occur while I am in the trial?
If you decide to join a randomised clinical trial, you will be given either the best existing treatment or a promising new treatment. You will be allocated at random to receive one treatment or the other. In clinical trials, people’s health and progress are carefully monitored. If you do join a clinical trial, you have the right to withdraw at any time. Doing so will not affect your treatment for cancer. It is always your decision to take part in a clinical trial. If you do not want to take part, your doctor will discuss the best current treatment choices with you. top of page
|Much of this material was taken from a patient information publication of Cancer Council Victoria entitled “Melanoma”. We are grateful for their cooperation in allowing this material to be reproduced here. top of page|
|Victorian Melanoma Service : the Alfred Hospital, Commercial Rd Prarhan|