What is Melanoma?
Melanoma is a type of skin cancer that develops from pigment-producing cells known as melanocytes. When melanoma is detected early, it can often be treated successfully by surgically removing the tumor. However, melanoma can be dangerous if it spreads to other parts of the body.
Melanoma most often develops on areas of the skin exposed to the sun. It can occur anywhere on the body, but is most common on the back, legs, arms and face. Melanoma can also develop under the nails, on the palms of the hands and soles of the feet, and in the mouth or genital areas.
Melanoma typically appears as an unusual mole or other skin growth. It may develop from an existing mole or appear on its own. Be on the lookout for any new spots on your skin, or changes in the size, shape, color or feel of an existing spot. Signs of melanoma include:
- Asymmetry – the two halves don’t match
- Borders – uneven, scalloped or poorly defined
- Color – varied shades of black, brown and tan
- Diameter – larger than 6mm (about the size of a pencil eraser)
- Evolving – changing over time
If you notice any of these warning signs, or anything else unusual, see your dermatologist right away. The earlier melanoma is detected, the better the chances for successful treatment.
Can Melanoma Be Completely Removed?
The short answer is yes, melanoma can often be completely removed with early detection and proper treatment. When melanoma is limited to the outermost skin layer and has not advanced deeper or spread to lymph nodes or distant sites, surgical removal of the tumor is typically curative.
The standard treatment for early stage melanoma is surgical excision – cutting out the tumor and a margin of normal-looking skin around it. The width of the margin depends on the thickness of the melanoma tumor, measured in millimeters. Thinner tumors require a smaller surgical margin, while thicker tumors need a wider excision.
For very thin melanomas limited to the epidermis (the top layer of skin), surgical margins of 0.5-1 cm are standard. For thicker melanomas extending deeper into the dermis, surgical margins of 1-2 cm or more may be recommended. Melanoma in situ, which has not invaded past the epidermis, can usually be treated with a 0.5 cm margin.
In addition to removing the primary tumor, doctors may evaluate the lymph nodes near the melanoma to determine if the cancer has spread there. This is known as sentinel lymph node biopsy. If melanoma is found in the lymph nodes, these may also need to be removed.
When performed correctly by an experienced dermatologic surgeon, surgical excision can remove a melanoma tumor completely. However, there is still a chance of recurrence if any cancer cells were left behind. Patients will require close follow-up and monitoring, especially if the melanoma was more advanced.
Factors Affecting Complete Removal
Several factors affect the likelihood of completely removing a melanoma tumor:
- Thickness – Thinner tumors are easier to remove fully.
- Location – Tumors on the scalp, fingers, toes and other delicate areas are harder to excise with adequate margins.
- Margins – Wider surgical margins make complete removal more likely.
- Subtype – More aggressive melanoma subtypes may be harder to eradicate.
- Ulceration – Melanomas that are ulcerated are associated with a higher risk of spread.
Regular skin exams and early recognition of changes can help detect melanoma when it is thinnest, making complete surgical removal very possible.
What Happens After Melanoma Is Removed?
The initial treatment for melanoma is surgical removal of the tumor. But additional therapy may be recommended, depending on the stage of melanoma and risk of recurrence.
If melanoma is diagnosed at an early stage, with small tumor thickness and no evidence of spread, regular follow-up exams with your dermatologist may be the only additional treatment needed. These visits involve a full body skin exam to look for signs of new melanoma or recurrence of the original melanoma.
For patients with higher risk melanomas, further treatment such as additional surgery, immunotherapy drugs, radiation therapy or chemotherapy may be recommended after the initial tumor removal. This adjuvant therapy is used to eliminate any remaining cancer cells and lower the risk of recurrence.
Follow-Up Treatment Options
Treatment after the initial melanoma surgery may include:
- Wider excision – Removing more tissue around the tumor site.
- Lymph node surgery – Sentinel lymph node biopsy or complete lymph node dissection.
- Immunotherapy – Drugs to boost the immune system to fight melanoma cells.
- Targeted therapy – Drugs that specifically act on melanoma cells based on genetic traits.
- Radiation – High energy beams to eliminate remaining cancer cells.
- Chemotherapy – Drugs to kill rapidly dividing cancer cells.
The type and extent of adjuvant treatment will depend on each patient’s unique situation. Your melanoma doctor will determine the best course of action based on the tumor characteristics and your overall health.
What Is the Outlook After Melanoma Removal?
When detected and treated early, the vast majority of melanoma cases are curable with surgery alone. The prognosis following melanoma removal is excellent when it is diagnosed at an early stage before spreading beyond the skin.
According to the American Cancer Society, the 5-year survival rate by stage for melanoma is:
- Stage 0 (melanoma in situ) – Nearly 100%
- Stage 1A – 97%
- Stage 1B – 92%
- Stage 2A – 81%
- Stage 2B – 70%
- Stage 3A – 78%
- Stage 3B – 59%
- Stage 3C – 40%
- Stage 4 (metastasized) – 23%
As these statistics show, early detection and treatment of melanoma leads to much higher chances for long-term survival. Lower stage tumors have an excellent prognosis following complete surgical removal. More advanced melanomas have a higher risk of spreading and poor outcomes.
Risk of Recurrence
For early stage melanoma, the risk of cancer coming back after treatment is low. But patients will need to be closely monitored for signs of recurrence or new melanomas. Lifelong skin exams every 3-12 months are recommended.
Those with more advanced melanoma have a higher chance of the cancer recurring. Additional treatment is often used to try to prevent this. Melanoma can sometimes come back years later, so continued follow-up care is essential.
Let your dermatologist know right away if you notice any new, changing or unusual spots on your skin, as catching a recurrence early maximizes treatment success. Stay vigilant about sun protection and avoid tanning beds, as sun exposure increases melanoma risk. Self skin exams each month can also help find any concerning changes early.
When Might Further Treatment Be Needed After Melanoma Removal?
For very early stage melanoma, surgical removal is sometimes the only treatment required. But patients with higher risk tumors may benefit from additional treatments to reduce the chances of recurrence.
Further treatment is more likely to be recommended if the initial melanoma:
- Is large in size
- Is thicker than 1-2 mm
- Has ulceration
- Has spread to lymph nodes
- Is an aggressive subtype like nodular or acral lentiginous
- Recurs after initial treatment
- Spreads to other parts of the body
Additional treatments such as immunotherapy, radiation, targeted drugs or chemotherapy can eliminate remaining cancer cells and improve prognosis. Your doctor will discuss if adjuvant therapy should be considered based on your particular situation.
Who Should Receive Extra Treatment?
Guidelines generally recommend discussing further treatment for patients with these higher risk melanomas:
- Stage IIA melanoma who are younger in age
- Stage IIB or IIC melanoma
- Stage III melanoma
- Stage IV melanoma
For example, immunotherapy drugs may be advised after surgery for patients with lymph node involvement or late stage III/IV melanomas. Your melanoma doctor will review your options and make personalized recommendations.
What Are the Latest Treatment Advances for Melanoma?
Exciting progress has been made in recent years with new technologies and therapies to treat melanoma beyond just surgical removal:
Improved Early Detection
Advanced dermoscopy devices and digital imaging techniques allow doctors to identify melanoma in its earliest stages. This enables complete removal at the initial phase before extensive spread occurs.
Targeted Drug Therapies
Newer targeted drugs can selectively attack melanoma cells based on specific genetic mutations, unlike traditional chemotherapy. Examples include drugs that block BRAF gene mutations common in melanoma.
Immunotherapy
Medications called immune checkpoint inhibitors boost the body’s own immune system to better recognize and destroy melanoma cells. Several immunotherapy drugs have been approved for melanoma treatment.
Precision Medicine
Analyzing the genetics of an individual melanoma tumor guides doctors to the most effective drug therapy. This personalized approach based on the tumor’s molecular profile improves outcomes.
Combination Treatments
Using surgery along with advanced radiation, chemotherapy, immunotherapy and targeted drugs together is more effective than single modalities alone. Combinations maximize melanoma removal.
Improved Radiation Techniques
New technologies like proton beam therapy allow delivery of higher radiation doses to melanoma tumors while reducing damage to surrounding healthy tissues.
Conclusion
When detected in its earliest stages, melanoma can often be completely removed through surgery alone with excellent prognosis. However, melanoma becomes more difficult to treat and cure as it advances. That’s why routine skin self-exams and prompt medical evaluation of any suspicious moles is so important. If melanoma spreads to lymph nodes or distant organs, outcomes are poorer. But new treatments give hope for improved survival even in late stage disease. With early recognition, appropriate surgery and adjuvant therapies as needed, melanoma can often be effectively treated before it spreads. Patients should have regular follow-up exams to monitor for recurrence and discuss any warning signs with their doctor right away.
