1. I've just been diagnosed with melanoma. What happens now?
Not all melanomas are the same and the majority are curable. Melanoma is a wide ranging diagnosis some which behave in a benign mannner and others in an aggressive way. It is important to see a specialist in this area to ensure that the correct treatment is carried out.
2. What is the difference between a melanoma and a malignant melanoma?
There is no difference between these terms, as both mean the same thing. As all melanomas are considered as malignant, it is redundant to use the word malignant again. Malignant melanoma is an old term. The modern term is simply melanoma.
3. What’s a melanoma specialist called and how does one find a good one?
Melanoma is primarily a surgical disease when confined to the skin. A melanoma specialist is someone who has spent time training at a melanoma unit and is aware of the behaviour of specific types of melanoma. There are now very good guidelines as to how melanoma should be treated. A good specialist will have access to the latest treatment and access to clinical trials. Your General Practitioner should be aware of any Melanoma Unit or Specialist in your area.
4. What do levels and stages mean?
The Level of melanoma is the depth to which the melanoma cells have grown into the skin. This is measured by the pathologist in millimetres termed the Breslows Thickness or alternatively and not as useful the Clarkes Level which is the anatomical layer in which the cells are seen.
The Stage gives some idea as to how far the melanoma has spread: Stage 1 and 2 confined to skin, Stage 3 to lymph nodes, and Stage 4 to internal organs. There is often confusion between the Clarkes level on the pathology report and the stage. It is important to note that they are completely separate.
5. What’s the difference between melanoma on the outside and melanoma on the inside?
Early stage melanoma is confined to the skin (outside ) and if fully removed without any spreading in the lymphatics or blood stream will be cured by surgery. Melanoma that has spread from the skin to lymph nodes or internal organs is more difficult to treat and therefore more serious(melanoma on the inside.)
6. My doctor removed my melanoma but now I have to go back and have more taken away. Why can’t they get it right in the first place?
There are several reasons why you may be advised to have another surgical procedure. Usually the reason why the second operation is needed is because the pathology examination from the first excision has provided further information to guide the surgeon. Needing another operation does not mean that the surgeon was careless or negligent.
i) Most commonly, the mole that was removed at the first operation was not known to be a melanoma before it was removed. When the diagnosis is uncertain before the surgery, it is usual to remove the mole with a thin rim of normal looking skin. If the mole is found not to be a melanoma, and is not of concern, then the smaller operation means a smaller scar and a better long term appearance. However, if the mole turns out to be a melanoma, then the thin rim of normal looking skin may contain melanoma cells that could allow the melanoma to recur. Therefore, a wider margin of skin is removed, to be certain that the melanoma has been totally removed.
ii) Sometimes the pathology report from the first operation indicates that some melanoma cells may not have been removed. As these melanoma cells are only visible under a microscope, the skin around the mole probably looked normal. Therefore, a second operation is needed to completely remove all melanoma cells.
iii) Another reason for a second operation is to remove lymph glands (also called lymph nodes) that may contain melanoma. Again, concern that the lymph nodes may contain melanoma may only be known after the first operation.
7. What’s the new vaccine that I’ve heard can cure melanoma?
Firstly, it is important to understand that vaccine treatments in melanoma are experimental treatments. They are not the usual or standard treatments. Vaccine treatment of melanoma has been carried out for several decades, with varying results. Some melanomas certainly respond to vaccines, whereas the majority do not seem to respond very well to vaccines that have been used in the past.
However there are new types of vaccines being developed, which are hoped will have improved results. If people with melanoma want to know whether a vaccine treatment is appropriate for them, they should ask their surgeon or oncologist, who can provide advice. However, as most vaccines for melanoma are experimental, or investigational, they may not be freely available and may be available only as part of a clinical trial.
8. I’ve heard about some people going to Sydney for treatment. Why’s that? Should I go to Sydney?
Yes, it is true that some people with melanoma have travelled to Sydney and other Australian cities for treatment of melanoma. There are several reasons for this.
i) The Sydney Melanoma Unit is a world renowned centre with a well deserved reputation for excellence. Many New Zealanders have heard about this centre and wish to have an opinion from the specialists there.
ii) There are some treatments and investigations (tests) that have been available only in Australia. These include a PET scan, which has been available in Australia for over 10 years but is available on a very limited basis in NZ.
iii) Many New Zealanders have family in Australia who encourage their family members across the Tasman.
iv) A number of clinical trials assessing new chemotherapy drugs are not available in NZ. Patients wanting access to these drugs usually have to go to Australia, although in some cases the drugs can be sent to NZ.
So, should a New Zealander with melanoma go the Australia for an opinion or for treatment? In general the answer is “No”. For most people diagnosed with melanoma, the treatment and prognosis is excellent, with equal results to those in Australia. Doctors in NZ can easily contact their colleagues in NZ or Australia for advice.
Also, as doctors in NZ and Australia collaborated to produce a world class guide to the treatment of melanoma that was published in 2008. There are now several melanoma specialists in NZ who have trained and worked at the Sydney Melanoma Unit. These specialists have world class expertise and will refer patients overseas if it is necessary. If persons with melanoma are concerned whether they should go to Australia for a second opinion, they should ask their surgeon or oncologist. This includes the possibility to have PET scans or to receive particular drugs or vaccines that may not be available in NZ.
9. My workmate’s had 14 skin cancers removed and he’s absolutely fine. What’s all the fuss about?
There are many types of skin cancer. The most common are Basal Cell Carcinomas (BCC) and Squamous Cell Carcinomas (SCC). Almost 2 out of three NZers of European descent will get one in their lifetime. Most are easily treated with excision (removal).There is a risk of metastasis (spread) with aggressive SCC’s or in people whose immune system is compromised. Melanoma is the most aggressive form of skin cancer but the prognosis is variable depending on a number of factors. So depending on what type of skin cancer you have, the outlook can be very different.
10. I’m of Maori descent – Ngati Porou. I guess I’m pretty safe from developing melanoma?
Unfortunately no. Less than 1% of NZ’s melanoma is found in “Pacific Peoples” including Maori, but it tends to be more advanced at diagnosis and therefore worse. Although less common you should be vigilant.
11. I had a melanoma excised a year ago. Can I still go to the beach with the kids in swimwear? Do I need to cover up totally? Is a hat and sufficient cream on my body enough?
No tan is a safe tan. We recommend against recreational tanning as we do against smoking. If you or your children venture outside in summer then always remember: slip, slap, slop, slide and seek shelter (the 5 “S’s”). Always avoid the midday sun and never burn.
12. My sister has Stage 4 melanoma, but she never sunbathed. Why do you people place so much emphasis on being sun smart when you can still get melanoma anyway?
Greater than 90% of melanoma is caused by UV radiation (from the Sun). The only way to decrease your risk of melanoma is to avoid excess UV radiation by applying simple rules (slip, slop, slap, slide, seek). The next best thing is to check your skin and seek advice if you have any new or changing moles. Early detection of melanoma can save lives.
