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Melanoma is the most dangerous type of skin cancer. It may appear as a new spot or as a change in an existing mole or freckle. If caught early, most melanomas can be cured. The biggest risk factor for developing melanoma is overexposure to UV radiation from the sun. There are three major types of skin cancer, each named after the type of cell they start from. These are squamous cell carcinoma, basal cell carcinoma and melanoma. Melanoma is the most dangerous. If untreated, melanoma can spread to other parts of the body and may not be curable. Australia has the highest rate of skin cancer in the world. Melanoma is the fourth most common cancer in Australia with over 2,000 people in Victoria alone diagnosed each year. Melanoma is usually diagnosed in older people; however, young adults, teenagers and even children can be affected. Symptoms The first sign of melanoma is usually a new spot or an existing mole or freckle that changes in appearance. Some of the changes might be: • • • • • The spot may grow larger. The edges of the spot may look irregular rather than smooth. The spot may be mottled with a range of colours such as brown, black, blue, red, white or light grey. The spot may be itchy or may bleed. The change usually happens over weeks or months, not days.
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UV radiation and other risk factors Overexposure to UV radiation from the sun and other sources is the major cause of melanoma. Repeated bouts of sunburn, particularly during childhood, greatly increase the chance of getting melanoma. People with fair skin are at higher risk of developing melanoma than those with darker skin. The melanin in darker skin offers some protection against the damaging effects of UV radiation, but it is no substitute for sunscreen and adequate protective clothing. While melanoma usually occurs on parts of the body that have been sunburned, it can sometimes start in parts of the skin or other parts of the body that have never been exposed to the sun. Melanomas on the arms and legs are usually detected earlier and have a better chance of cure than melanomas on the body, neck or head (which are usually detected at a later stage). Once melanoma is diagnosed and treated, regular skin checks are advised, since there is an increased risk of further melanomas developing. Some people are more prone to melanoma because of inherited factors. Adults with a large number of moles on their body (over 200) are at higher risk of melanoma. Diagnosis Melanoma is diagnosed by: • • Physical examination – including medical history. Biopsy – under local anaesthetic, the suspected melanoma and some of the surrounding skin is removed. The sample will be examined in a laboratory for signs of cancer.
Further tests If melanoma is diagnosed, further tests may be needed to see if the cancer has spread to other areas of the body. These tests may include: • • Blood tests Chest x-ray
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• • • • •
Ultrasound scan Magnetic resonance imaging (MRI) scan Computed tomography (CT) scan Bone scan Lymph node biopsy.
Treatment Treatment depends on the stage of the melanoma, which may include: • • • Early stage melanoma – stage 1 High-risk melanoma – stages 2 or 3 Advanced stage melanoma.
Treatment may also be needed to: • • Help stop the cancer coming back Treat melanoma that has come back locally.
Treatment for early stage melanoma In its early stages (stage 1) when there is no spread, melanoma is confined to the uppermost layer of the skin (epidermis). Treatment involves having the affected mole removed with surgery. This may be done in your local doctor’s surgery using local anaesthetic. Your doctor will take the mole plus a margin of surrounding healthy tissue from around the melanoma. Doctors call this a ‘wide local excision’ and this is usually the only treatment that you will need. Treatment for high-risk melanoma If the melanoma has spread to deeper skin layers, the affected tissue will need to be removed under general anaesthetic. Your doctor may call this ‘high-risk melanoma’ or ‘stage 2 or 3 melanoma’. Depending on the amount of skin removed, the wound is closed with stitches, a skin graft or flap repair. Your doctor may also suggest that you have a test done called a ‘sentinel node biopsy’. This is a fairly new test that helps stage your cancer. It looks to see if the cancer has spread to your lymph nodes. If any of your lymph nodes are found to have cancer cells, your doctor will then want to do an operation to have them taken out. This can be quite a big operation. The type of surgery will depend on where in the body your melanoma began. There are large groups of lymph nodes in the groin, armpits and neck. If you had a melanoma begin on the leg, the lymph nodes in the groin on the same leg will be taken out. If it began on your scalp, the lymph nodes on the same side of the neck will be removed. Radiotherapy is sometimes used following lymph node removal to kill any remaining cancer cells and reduce the risk of the cancer coming back (recurring). Radiotherapy involves the use of precisely targeted x-rays. Treatment for advanced melanoma For advanced stage melanoma, you may be offered chemotherapy, radiotherapy or immunotherapy – or a combination of the three. These treatments will not cure your cancer at this stage, but they will usually help to control it along with any symptoms it is causing. Your doctor may call this ‘palliative treatment’. Treatment to help stop the cancer coming back You may also be offered other types of treatment after your surgery to help stop the cancer coming back or spreading. Because doctors are still unsure about whether or not this will help, these treatments are usually given as part of a clinical trial. It may include having some cancerkilling drugs such as chemotherapy or biological therapy (immunotherapy). Treatment for local recurrence For melanoma that has come back locally (local recurrence), you may be given chemotherapy or immunotherapy directly into your arm or leg without it circulating to anywhere else in the body. This is called ‘isolated limb infusion’ or ‘regional limb infusion’. If you have this treatment, you will need to have a general anaesthetic so that the doctor can stop the blood circulation to that limb while the drug is given. This treatment can only be given to people whose melanoma has come back near to where it began. Side effects from treatment
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All treatments can have side effects. What these are will depend on the type of treatment you are having. It is very important that you fully understand how your treatment may affect you. Your medical team should explain all the possible short and long-term side effects before you begin your treatment. Follow-up After your treatment for melanoma, your doctor will probably want you to have regular follow-up appointments. If your cancer was very early stage, your doctor may discharge you altogether at some point. However, it is very important to remember that, once you have had a melanoma, you are at a much higher than average risk of developing another one. This means that you should never sunbathe or use sun beds. Look after your skin and always take precautions in the sun. If you develop any changes in your skin or enlarged lymph glands near to where you had the cancer, you should see your specialist as soon as possible. Where to get help • • • • Your doctor Dermatologist The Cancer Council Helpline Tel. 131 120 Multilingual Cancer Information Line, Victoria
Things to remember • • •
Melanoma is the most dangerous type of skin cancer. A melanoma may appear as a new spot or as a change in the appearance of an existing mole or freckle. Treatment depends on whether or not the cancer has spread to other areas of the body and may include surgery, chemotherapy, immunotherapy and radiotherapy.
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