Sun worshippers of the early 21st century continue to ignore the medical evidence. Staying too long in the sun without some form of protection can result in the formation of skin cancer. Of all the types of skin cancer, melanoma is the most severe. It is a malignant growth that may start in a mole found previously on your body or arises suddenly.
The name “melanoma” is derived from the point of origin – the cells that produce skin pigmentation – melanin. Melanoma frequently appears on the legs of women over 40. It is more often discovered on the backs of men of the same age. Since about the middle of the 1940s, the number of cases of melanoma has steadily increased. In fact the figures suggest that approximately 1 out of every 34 Americans will be at risk for developing this form of skin cancer during their lifetime.1 If you think a tan is worth the risk, think again. The standard remedy for melanoma is surgery.
Cutting Out Melanoma
Al melanomas have different patterns and characteristics. When you receive a diagnosis of melanoma, you have a few surgical options. Your choices will depend upon several factors:
- The stage of the disease – is it still present only in the outer layers of the skin or has it spread below to additional layers and even organs?
- The thickness of the melanoma
- Location of the melanoma
- What the repair work will require.
- The outcome of the initial surgery – the biopsy
- The DNA content of the melanoma – this may not affect the actual removal process, but it will help determine how responsive the cancer will be to specific types of treatments and after care2
In addition, the surgeon will consider your overall health and well-being as well as your age and other related factors.
Types of Surgery
Essentially, there are three types of surgery to try to prevent melanoma from spreading and to remove it permanently. These are called biopsy and conservative re-excision and wide excision. Biopsy is the removal of a portion or all of the suspected cancer growth for examination. It is the first step in the process.3 Excision refers to the removal of any body part by separating it from the skin tissue. It generally refers to the removal of a tumor, gland or growth.
For melanoma, a wide excision (or simply re-excision) indicates that the removal covers a larger area of skin tissue. A conservative re-excision excision is restricted to a smaller section of skin and tumor. Both surgical procedures follow the initial biopsy which determines whether you require narrow or wide excision.4
The Procedures – Biopsy and Sentinel Lymph Node Biopsy (SLNB)
If you have melanoma, you may be subjected to two types of biopsy. The first is a simple incision or excision performed in your doctor’s office. After applying local anesthetic, he or she will cut out the affected part. It will be done by either “shaving” a piece of the suspected cancer tumor, “punching” it out using a cookie-cutter like tool or excising or incising (cutting) it out. The entire procedure may require a stitch or two but, overall, is considered fairly painless.5
The sample is sent to a pathologist for examination. He or she tests it see how far the cancer cells have spread in the cells. A dermatologist may also receive a sample for consideration. In some instances a biopsy will be required to identify the type of melanoma. Other times, if there are indications of possible spread to the lymph nodes, a surgeon will perform a sentinel lymph node biopsy or SLNB.
The SLNB biopsy is a simple process. The surgeon applies anesthetic to the affected area. A blue dye is injected, along with a radioactive tracer. The target is the sentinel lymph node. This particular lymph node acts as a warning system. The surgeon then can trace the position of the node.
The surgeon will use a fine and sharp instrument to cut into and remove a sample of the sentinel lymph node. This is then taken for examination by a pathologist. The sample will determine the stage, spread and depth of the cancer. If, for example, it is clear, the cancer has not spread into the rest of the nodes. The biopsy thus will help your surgeon decide on how to proceed indicating what method, or methods, will prove to be the most effective against your stage of melanoma.
The Procedures – Conservative Re-Excision
When a surgeon performs conservative re-excision, it indicates that the tumor has not spread beyond its site of origin or has confined itself to a narrow region. It is, essentially a procedure that removes any cancer cells or growth remaining following the biopsy. During the process, the surgeon will also remove a small amount of skin around the area.6
The Procedures – Wide Re-Excision
Wide re-excision often applies to Stage II and later of Melanoma. It may or may not be combined with a SLNB. 7This approach is used for tumors that are wide and exhibit depth. During the process, the surgeon will remove an amount of skin – enough to require either the repair through stitches or skin tape or the need for a skin graft or plastic surgical flap. You will require pain pills for several days.
Surgery may remove most if not all of the cancer cells. In order to help ensure the complete destruction of all cancer cells, most patients with melanoma may have to undergo other therapies. If the growth was small, but certainly if it had spread, you would be expected to also have other treatments. Among the more common ones are biological therapy or immunotherapy, chemotherapy and radiation therapy. You may utilize one or any combination of these different forms of treatment.
References
Sarg, M. S. and Gross, A. D. (2007). The Cancer Dictionary Third Edition. New York: Checkmark Books.
1 University of California, Medical Centre (2011) “Melanoma” Retrieved from general.surgery.ucsf.edu/conditions–procedures/melanoma.aspx
2 Kanzler, M H., and Mraz-Gernhard, S. (2002). “Primary Cutaneous Malignant Melanoma and Its Precursor Lesions: Diagnostic and Therapeutic Overview.” Retrieved from www.hudlaeknastodin.is/page67/assets/Primary%20cutaneous%20malignant%20melanoma%20.pdf
3 Melanoma International Foundation (2011). “Biopsy: The First Step.” Retrieved from www.melanomaintl.org/melanoma_info/pathology.html
4 American Cancer Society (2011). “Melanoma Diagnosed.” Retrieved from www.cancer.org/Cancer/SkinCancer-Melanoma/DetailedGuide/melanoma-skin-cancer-diagnosed
5 American Cancer Society (2011). “Melanoma treatment – Surgery.” Retrieved from www.cancer.org/Cancer/SkinCancer-Melanoma/DetailedGuide/melanoma-skin-cancer-treating-surgery
6 Ibid.
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