Melanoma

Melanoma is the most serious skin cancer and is increasing at a rate faster than any other cancer.

Risk Factors

  • Family or personal history of melanoma
  • Blond or red hair; blue, green or gray eyes
  • Fair skin
  • Freckling of the upper back
  • Three or more blistering sunburns before the age of 20 years
  • Presence of actinic keratosis/dysplastic nevi (moles that are more likely to become cancerous than ordinary moles)
  • Numerous ordinary moles (more than 50)
  • Weakened immune system
  • Ultraviolet (UV) radiation

Distinguishing Lesions

Most pigmented skin changes are benign (not cancerous), but approximately one third of all melanomas arise from pigmented moles. It is of utmost importance to distinguish between benign and malignant lesions by using the ABCD method:

  • Asymmetry
  • Border (irregular)
  • Color (variegated or more than one color)
  • Diameter (greater than 6 millimeters)

Staging and Prognosis

Tumor thickness is the most important factor in deciding the outcome (prognosis) and is more accurate than the level of invasion. Tumors less than one millimeter thick have a cure rate greater than 95 percent, whereas 10-year survival for persons with lesions more than four millimeters thick is 46 percent. Thickness has been correlated with the risk of the tumor traveling to other organs and to lymph nodes in the area of the tumor. Older age, male gender and presence of satellitosis (metastatic melanoma in the skin adjacent to the primary tumor), ulceration and location on the back, back and outer side of the arm, neck or scalp all carry a worse prognosis. The presence of spread (metastasis) to lymph nodes in the area can mean a poor outcome. Distant metastasis, to other organs and other parts of the body, has a dismal prognosis.

Treatment

Wide local removal of the tumor by a surgeon is the best treatment for most melanomas and premalignant lesions. The size of the excision (surgical margins) depends on the tumor thickness.

Some surgeons believe in removing the lymph nodes as a precautionary measure even if they don’t have cancer. Studies have shown lymph node removal in tumors that are one to four millimeters in size significantly improves survival, especially for those patients under 60 years of age. Lymph node removal has not proven to be helpful for other subgroups. The current standard of practice is for the surgeon to explore all of the lymph nodes during surgery and to remove those that are shown to have cancer cells. Surgeons know how the lymph system drains and the order of the drainage. They track the drainage to what is called the sentinal lymph node. If the sentinal lymph node is benign (no cancer), the patient can avoid more radical surgery.

Adjuvant Therapy

Radiation therapy, isolated limb profusion, systemic chemotherapy and other forms of immunotherapy have not proven to be very effective. Interferon has been shown to improve overall survival in approximately 20 percent of patients with stage III melanomas. Screening for Interferon is performed on an individual basis. Age, current medications and psychological status all are major factors in determining whether Interferon is an appropriate therapy or not.

Continuous and frequent skin inspection is the most important tool to identify recurrence, metastasis or new lesions.

Surgeons who treat melanoma:

Jeffrey Moley, MD 
Rebecca Aft, MD, PhD
Ryan Fields, MD

For an appointment with a Washington University endocrine and oncologic surgeon, please call (314) 362-2280.

More information on melanoma:

Early Detection Assists in Fight Against Melanoma
Siteman Cancer Care Center on Skin Cancers and Melanoma
National Cancer Institute CancerGov Web Page on Skin Cancers and Melanoma