How does my doctor know I have Melanoma Skin Cancer?

Q: What do I do if my doctor thinks I might have cancer?
A: You should feel free to ask any question that's on your mind, no matter how small it might seem. Here are some questions you might want to ask.

  • Would you please write down the exact type of skin cancer I have.
  • How far has my melanoma spread within or beneath my skin?
  • How thick is the melanoma?
  • What treatment choices do I have? What do you recommend and why?
  • What are the risks and benefits of each?
  • What is the goal of this treatment?
  • Will I have a scar after my treatment?
  • What should I do to be ready for treatment?
  • Will I lose my hair? If so, what can I do about it?
  • What are the chances of my cancer coming back with the treatment you suggest? What would we do then?
  • Should I take special care to avoid sun exposure?
  • Do I need follow-up appointments to check for recurrence or a new cancer?
  • Should I arrange to have my family members screened?

Q: How Is Melanoma Skin Cancer Treated?
A: After the tests are done, your doctor will talk to you about treatment options. The best choice depends mostly on the thickness of the tumor and the stage of the disease.

Surgery
Surgery is the main treatment for most cases of melanoma. It can often cure early stage melanomas.

  • Simple excision
  • Wide-excision (re-excision)
  • Amputation
  • Lymph node dissection
  • Surgery for melanoma that has spread

Chemotherapy
Chemotherapy ("chemo") is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. Chemo is useful in treating cancer that has spread

Immunotherapy

  • Cytokines for advanced melanoma
  • Interferon-alpha
  • Melanoma vaccines
  • BCG (Bacille Calmette-Guerin) vaccine
  • Imiquimod cream

Radiation therapy
Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. External beam radiation focuses radiation from outside the body on the skin tumor. This may be used to treat some patients with melanoma

Q: What is the staging of melanoma?
A: Staging is the process of finding out how widespread the cancer is. This includes finding out how big it is and whether it has spread to the lymph nodes or any other organs. The tests described above are used to help decide the stage of the melanoma. Staging is very important because the treatment and the outlook (prognosis) for your recovery depend on the stage of the cancer.

Stages are labeled using 0 and the Roman numerals I through IV (1-4). In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer.

There are really 2 types of staging for melanoma. The clinical stage is based on what is found in the physical exam, biopsy, x-rays, CT scans, and so on. The pathological stage uses all of this information plus what is found during biopsies of lymph nodes or other organs. So the clinical stage (which is done first) may be lower than the pathologic stage, which is found after the biopsy.

After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to explain your stage in a way you understand. This will help you both decide on the best treatment for you.

Q: What check-ups should a woman have after treatment for melanoma cancer?
A: After your treatment is over, it is very important to keep all follow-up appointments. Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments. This is the time for you to ask your health care team any questions you need answered and talk about any concerns you might have.

Your follow-up should include regular skin and lymph node exams by yourself and by your doctor. How often you need follow-up visits depends on the stage of your melanoma when you were diagnosed. Along with the exams, blood and imaging tests may be recommended for some patients.

The follow-up schedule for melanomas thinner than 1 mm often calls for physical exams every 3 to 12 months for several years. If these exams are normal, you can then get check-ups once a year. Your doctor may want to see you more often if you have many moles or a few atypical moles.

For thicker melanomas, the schedule might include physical exams every 3 to 6 months for 2 years, then every 3 to 12 months for the next 2 years. After that, exams are done at least once a year. Some doctors also recommend chest x-rays (to detect lung metastases) and certain blood tests (to detect liver or bone metastases) every 6 to 12 months. Other tests such as CT scans may be done too, especially for people who had more advanced stage disease.

This information was provided by the American Cancer Society. (www.cancer.org).