This information is currently under review
This information has been reviewed by:
Professor John Kelly, Dermatologist
Lymph node biopsy and dissection
Risk of further melanomas: follow-up
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. For most people who develop melanoma, surgery is all that is required.
Melanomas are always removed by surgery. The tumour is cut out, along with a small area of normal-looking skin from around the melanoma. All melanomas need to be removed with a safety margin of normal skin.
People with a melanoma which has grown deeper into the skin may need to be admitted to hospital so a larger amount of skin can be cut out. This makes sure all the cancer cells have been removed. This usually requires a general anaesthetic.
This is generally done in a second procedure. This margin will vary from 5 mm to 2 cm according to the depth of the melanoma. The purpose is to remove any persisting melanoma in the surrounding skin and to prevent the melanoma growing back at the same site.
Sometimes a skin graft is required to cover the wound. For the graft, the surgeon will take a layer of skin from another part of your body and place it over the wound.
The other possibility is to do a ‘flap', where the surgeon will close the wound using a nearby flap of skin. Most people however will be able to have the skin sewn up without a graft or flap.
The wound will be covered with a dressing and left undisturbed for several days. It will then be checked to see if it is healing properly. If you had a skin graft, you will also have dressings on any area from which the skin was taken.
You may be uncomfortable for some days after your operation. If you have pain, tell your doctor or nurse so that they can give you painkillers.
If you have a skin graft, the area where the skin is grafted on may look unattractive immediately after the operation, but eventually it will heal and the redness will fade. There is a risk of infection, haematoma and scarring following surgery for melanoma. Occasionally, the skin graft fails: if this happens to you, your doctor will explain what further treatment you will need.
Recovery time from removal of a melanoma will depend on the thickness of the tumour and the extent of your surgery.
If there is suspicion that the melanoma might have spread to your lymph nodes, your doctor may recommend that you have a fine needle aspiration biopsy or a sentinel node biopsy.
In a fine needle aspiration biopsy, the doctor inserts a needle into the node suspected of being affected by cancer and draws tissue into the syringe. This tissue is then examined under a microscope to see if it contains cancer cells. Occasionally, a node is removed surgically (‘open biopsy') so that the tissue can be examined.
If cancer cells are found in the node/s, the nodes may be surgically removed (‘dissected').
A sentinel node biopsy locates the lymph nodes that drain fluid from the area where the melanoma developed. A harmless dye and a weak radioactive substance will be injected into the site of the melanoma. After about an hour, the surgeon will pass a hand-held machine called a ‘counter' over the area, and the sentinel nodes will be revealed by the location of the radioactivity. In a small operation, the lymph node stained with the dye will be removed and checked for cancer cells. Surrounding nodes may then be removed if cancer is evident. This is to try to stop it coming back in the same area.
Radiotherapy treats cancer by using radiation to kill or injure cancer cells. The radiation can be targeted onto cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue.
You will probably have radiotherapy once a day from Monday to Friday, with a break at the weekend, over several weeks. The number of visits you need to make will depend on the size and type of the cancer and on your general health.
The treatment itself only takes a few minutes, although you may need to wait before each treatment.
Radiotherapy does not make you radioactive, so it is quite safe to be close to your partner, children and others during the course of treatment.
Side effects of radiotherapy depend on the part of the body being treated. Radiotherapy for melanoma usually involves treatment to the skin and nearby lymph nodes. Side effects may include reddening of the skin. Others may occur, depending on where your treatment is. Talk with your doctor or the radiotherapy staff about any possible side effects and how to manage them.
Chemotherapy is the treatment of cancer with anti-cancer drugs. The aim is to kill cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing themselves.
In melanoma, chemotherapy is used as palliative treatment to try to control the growth of the cancer. Chemotherapy usually does not cure melanoma. Chemotherapy is usually given by injecting the drugs into a vein (intravenous treatment). There are other types of chemotherapy, including tablets, which may be suitable for you. Your medical oncologist will discuss these options with you.
Some drugs used in chemotherapy can cause side effects. They may include feeling sick (nausea), vomiting, feeling unwell and tired, and some thinning or loss of hair from your body and head. Generally, these side effects are temporary and can be prevented or reduced.
These days, new treatments are available that can help to make many side effects of chemotherapy much less severe than they were several years ago.
The medical oncologist will discuss these and other side effects and risks with you.
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.
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.
If you are part of a family where two or more close relatives have been diagnosed with melanoma, you and your family may benefit from referral to a family cancer centre. There, the risk of melanoma in all family members can be assessed and appropriate advice given.
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. In Victoria from September to April, UV radiation levels are 3 and above for most of the day. Particular care should be taken between 10 am and 2 pm (11 am and 3 pm daylight saving time) when UV radiation levels reach their peak.
The SunSmart UV Alert is issued by the Bureau of Meteorology when the UV Index is forecast to reach 3 and above. It is reported in most daily newspapers and some television and radio weather forecasts across Australia.
To protect against skin damage and skin cancer when the UV level is 3 and above, use a combination of five sun protection measures:
From May to August, UV radiation levels in Victoria are usually low (below 3). Therefore, sun protection measures are not necessary during these months unless you are in alpine regions, or near highly reflective surfaces like snow or water.
*The Global Solar UV Index is a rating system adapted from the World Health Organization.
It ranges from:
Updated Oct 2003
