Melanoma

Overview

Melanoma is a disease of the skin in which cancer cells are found in the melanocytes, the cells that produce color in the skin or pigment known as melanin. Melanoma usually occurs in adults, but it may occasionally be found in children and adolescents. Melanoma is an uncommon, but aggressive form of skin cancer.

Normally, the first sign of melanoma is a change in the shape, color, size or feel of an existing mole or a spot on the skin. The National Cancer Institute suggests using "ABCDE" to remember the five melanoma symptoms:

  • Asymmetry — The shape of one half is different from the other half.
  • Border is irregular — Edges of the mole are often ragged, notched or blurred in outline. Sometimes the pigment spreads into the surrounding skin.
  • Color is uneven — Shades of black, brown, tan, white, gray, red, pink or blue may be present.
  • Diameter change — Usually the size increases. Most melanomas are larger than the size of a pea.
  • Evolving — The mole has changed over the past few weeks or months.

Be aware that these symptoms could be due to conditions other than melanoma, so it’s best to see a doctor right away.

Our approach

The multidisciplinary team at Northwell Health is experienced in complex, high-risk cancers like melanoma. Within the first several days of a visit, the physicians will conduct comprehensive tests and develop a personalized melanoma cancer treatment program. 

Highlights of melanoma treatments and services include:

  • A continuum of care that includes many support services and collaboration with local and regional dermatology practices
  • Sophisticated surgical and reconstructive techniques
  • Cutting-edge approaches to delivering immunotherapy and chemotherapy
  • Precision radiation techniques — such as stereotactic radiation therapy and intensity modulated radiation therapy (IMRT) — that protect healthy tissue while targeting diseased areas

Each melanoma diagnosis is unique, so the team meets regularly to discuss each patient’s treatment. The specialists review each treatment phase to constantly improve skin cancer care and ensure treatment milestones are reached. 

From diagnosis through reconstruction and post-operative therapy, each patient is in the hands of experts every step of the way

Diagnosis

The first step to making a melanoma diagnosis is usually a physical, during which a doctor will examine skin all over the body to see if there are other unusual growths. The doctor will also consider medical history, melanoma risk factors and any related medical or precancerous conditions. If a doctor suspects that someone might have melanoma, the patient will undergo additional tests.

Specialists use a number of procedures and tests to deliver an accurate melanoma diagnosis as well as to determine the stage of the cancer (how far the cancer has spread). 

  • Biopsy — Using a local anesthetic, a doctor may remove all or part of the skin that looks abnormal. The sample is sent to a lab for analysis by one or more pathologists trained in evaluating skin cancers. A biopsy, usually an outpatient procedure, helps determine the "stage" of the cancer, or how far it has spread.  
  • Imaging tests — Melanoma diagnosis may include imaging tests such as:
    • Chest X-ray — Identifies any mass or spot on the lungs.
    • Lymphoscintigraphy — Checks the lymph system for the spread of melanoma.
    • Ultrasound — Uses high-frequency sound waves to detect if and where the cancer has spread.
    • CT or CAT (computerized axial tomography) scan — More detailed than an X-ray, this procedure uses X-rays and computer technology to produce detailed images. 
    • MRI (magnetic resonance imaging) — A powerful magnet, radio waves and computer imaging combine to create highly detailed pictures of areas inside the body.
    • PET (positron emission tomography) scan — Uses small amount of radioactive sugar to highlight the presence and stage of the melanoma.

With the data from these state-of-the-art tests for melanoma diagnosis, a doctor will develop a customized treatment plan.

Staging

The extent of melanoma is measured in several stages, depending on the size (width) of the growth, how deeply it has grown beneath the top layer of skin and whether cancer cells have spread to nearby lymph nodes or to other parts of the body. According to the National Cancer Institute, these stages are:

  • Stage 0: The melanoma involves only the top layer of skin. It is called melanoma in situ.     
  • Stage I: The tumor is no more than 1 millimeter thick (about the width of the tip of a sharpened pencil.) The surface may appear broken down (ulcerated). Or, the tumor is between 1 and 2 millimeters thick, and the surface is not broken down. 
  • Stage II: The tumor is between 1 and 2 millimeters thick, and the surface appears broken down. Or, the thickness of the tumor is more than 2 millimeters, and the surface may appear broken down.
  • Stage III: The melanoma cells have spread to at least one nearby lymph node. Or, the melanoma cells have spread from the original tumor to tissues nearby.
  • Stage IV: Cancer cells have spread to the lung or other organs, skin areas, or lymph nodes far away from the original growth. Melanoma commonly spreads to other parts of the skin, tissue under the skin, lymph nodes, and lungs. It can also spread to the liver, brain, bones, and other organs.

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