What is melanoma?
Melanoma is a type of skin cancer that develops from pigment-producing cells called melanocytes. When melanoma is caught early, it is highly treatable. But if it spreads to other parts of the body, it can be serious and life threatening. Melanoma accounts for only about 1% of skin cancers, but it causes the majority of skin cancer deaths.
The most common sign of melanoma is a new spot on the skin or a mole that is changing in size, shape or color. A spot that looks different from all of your other spots or freckles is also a warning sign. Changes in an existing mole, like itching, skin breakdown or bleeding, are also important to recognize.
What causes melanoma?
Ultraviolet (UV) light exposure from the sun or tanning beds is a major cause of melanoma. People with fair skin, blonde or red hair and light colored eyes are at greater risk. A family history of melanoma can also increase risk. Your immune system plays a role in controlling cancer, so people with weakened immune systems have a higher risk of melanoma. Rare genetic defects can also predispose someone to developing melanoma.
What are the stages of melanoma?
Melanoma is staged based on how far it has spread. Earlier stages have a better prognosis. The stages are:
Stage 0: Abnormal melanocytes are present but have not spread into deeper layers of skin. This is also called melanoma in situ.
Stage I: The tumor is less than 1 mm thick and has not spread beyond where it started.
Stage II: The tumor is 1 mm to 2 mm thick. It may or may not have spread to nearby lymph nodes.
Stage III: The melanoma is more than 2 mm thick and has spread to nearby lymph nodes or areas of skin.
Stage IV: The melanoma has spread beyond the skin and nearby lymph nodes to other organs such as the lungs, liver or brain.
What does melanoma surgery involve?
The primary treatment for melanoma is excisional surgery to remove the tumor and some surrounding normal skin. This is typically done as an outpatient procedure, using local anesthesia. The type of surgery depends on the stage:
Stage 0 and I: The tumor is cut out with a small margin of normal skin around it. Wider margins may be needed for melanomas on the head and neck where skin is thinner.
Stage II and III: Wider excision and lymph node removal may be done to help prevent recurrence. Sentinel lymph node biopsy can determine if the melanoma has spread to nearby lymph nodes.
Stage IV: Surgery is typically focused on removing melanoma that has spread to other organs like the brain or liver. Immunotherapy or other therapies are also used.
What is the likely recovery from melanoma surgery?
For early stage melanoma removal, recovery is often quick with few complications. Stitches are removed after 1-2 weeks. There may be some bruising, swelling and mild pain initially. Normal activity can typically be resumed in 1-2 weeks.
With lymph node removal or surgery for more advanced melanoma, there is a higher risk of complications like infection, bleeding or lymphedema. Recovery may take 4-6 weeks before normal activity is resumed. Physical therapy is often recommended after lymph node removal to prevent arm swelling and loss of mobility.
What are the potential risks and side effects of melanoma surgery?
As with any surgery, there are potential risks including:
– Infection of the surgery site or lymph node removal site
– Bleeding and hematoma formation
– Problems with wound healing and scarring
– Numbness or nerve damage near the surgery site
– Lymphedema (fluid build up and swelling) after lymph node removal
– Recurrence of melanoma near the surgery site or elsewhere
For early stage melanoma, recurrence rates are fairly low when the tumor is fully removed with clear margins. The risk of recurrence goes up with more advanced tumors. Regular skin checks and monitoring are important to watch for potential new melanomas or spread of the cancer.
How successful is melanoma surgery?
When detected early, melanoma surgery is highly successful. The 5-year survival rate for patients with stage 0 or I melanoma is over 95%. With stage II melanoma, the 5-year survival rate is about 65%. Once the melanoma has spread to distant lymph nodes or organs in stage III or IV, the outlook is less promising. The 5-year survival rate for stage IV melanoma is about 20%.
So the earlier melanoma is diagnosed, the better the chances with surgery. Any concerning new or changing skin growth should be evaluated quickly. Even if the spot looks somewhat benign, it is best to have it biopsied. Catching melanoma at the earliest most treatable stages gives patients the greatest chance for a full recovery.
What follow up is needed after melanoma surgery?
Patients who have had melanoma need close follow up care to watch for potential recurrence. A schedule of regular skin examinations by a dermatologist is very important. Patients are also educated about how to do monthly self-exams at home of their skin and lymph nodes to catch any new abnormalities.
Patients may need imaging tests like CT, MRI or PET scans periodically to look for any spread of melanoma to internal organs. Ongoing blood tests may also be used as a monitoring tool. If melanoma does recur after treatment, additional surgery, immunotherapy, chemotherapy or radiation may be necessary.
Can melanoma surgery prevent the cancer from returning?
When melanoma is detected and treated early, surgery provides the best chance for a cure and prevents cancer from recurring or spreading. The National Comprehensive Cancer Network estimates 10-year disease free survival rates for patients appropriately treated with surgery:
| Melanoma Stage | 10-Year Disease Free Survival |
|---|---|
| Stage 0 | Almost 100% |
| Stage I | 92-97% |
| Stage II | About 80% |
| Stage III | About 60% |
So for early melanoma, surgery provides an excellent chance for a cure. But melanoma can still sometimes recur, which is why ongoing monitoring and skin exams are so important. Higher stage tumors are more likely to return, so additional treatments are often needed.
When is a second surgery needed for melanoma?
Sometimes a second, wider excision is recommended if the initial margins around the removed melanoma were tight. This helps ensure no cancer cells were left behind.
A repeat surgery may also be done if the pathology report shows melanoma cells too close to the edges of what was removed. Wider margins lower the chances of recurrence.
If melanoma returns after initial treatment, additional surgery is typically done to remove the new tumor. This may be followed by immunotherapy or chemotherapy. For melanoma on an arm or leg, amputation of the limb may be required if the cancer persists or spreads.
Surgery can also be repeated to remove melanoma that has metastasized to other parts of the body like the liver or lungs. The goal is to remove all visible tumors, even when multiple surgeries may be needed. Removing metastases can improve survival, especially when other treatments are also used.
What are the less invasive treatment options for melanoma?
For early stage melanoma confined to the top layer of skin (in situ), treatments other than surgery may sometimes be appropriate. These include:
– Medicated creams like imiquimod (Zyclara) or 5-fluorouracil (5-FU)
– Laser therapy
– Photodynamic therapy (light activated chemical)
– Freezing with liquid nitrogen (cryosurgery)
These topical treatments can destroy melanoma cells without needing to cut the skin. They may lead to redness, swelling or blistering of the treated area. Healing typically occurs within a few weeks. Less invasive treatments are usually done for cases of melanoma in situ or lentigo maligna melanoma (on sun exposed areas in older people).
Surgery is still the standard treatment for invasive melanoma. There are currently no less invasive options for treating deeper melanoma tumors that have grown down into the deeper skin layers. Removing the tumor is necessary both for diagnosis and to prevent it from spreading.
Can melanoma surgery cure stage 4 cancer?
Once melanoma has advanced to stage 4 and spread widely throughout the body, it is very difficult to cure. But surgery still plays an important role in treatment.
Removing isolated metastases in the skin, lungs, liver or brain can help improve survival, especially when combined with immunotherapy or other therapies that help fight cancer throughout the body. Surgery helps reduce the overall tumor burden.
While it is unlikely to cure stage 4 melanoma on its own, surgery improves the chances that other treatments will be effective. It can allow some patients to live years longer than they otherwise would have. Repeated surgeries may be done over time to control emerging tumors.
Patients with limited metastases to only one part of the body have the best outcomes with surgery. Widespread stage 4 melanoma is harder to control. Overall, the 5-year survival rate with stage 4 melanoma is about 20%. While surgery alone cannot generally cure it, it remains a vital part of the treatment plan for managing advanced disease.
Conclusion
Melanoma surgery is very effective in treating the cancer when detected early at stage 0 or I. Success rates for surgery decline as melanoma progresses to more advanced stages. But surgery remains an important part of diagnosis, staging and treatment of melanoma at all stages, in combination with other therapies.
While a cure is difficult with stage 4 disease, surgery can prolong and improve quality of life. Ongoing monitoring and skin checks for the rest of a patient’s life are critical to try to catch any new melanomas as early as possible when recurrences do happen. The prognosis for melanoma very much depends on finding it early so it can be removed completely before spreading to other areas of the body.