Surgery - Lynn Dyess (trunk and extremity melanoma)
Surgery - Fred Silver (head and neck melanoma)
Medical Oncology (Tom Butler)
In the United States in 2013, there will be approximately 75,000 new cases of melanoma, including about 1,300 cases in Alabama alone. It is the 5th most common cancer in males, and the 7th most common cancer in females. Unlike more common cancers such as breast cancer and colorectal cancer, the incidence of melanoma continues to rise.
If detected early, melanoma is a very curable cancer, with an overall 5 year survival of 91%. This is an improvement on the 82% 5 year overall survival in the mid-1970s.
If the melanoma has not spread to lymph nodes or to distant organs, 5 year survival is 98%. If the melanoma has spread to lymph nodes but not distant organs, then 5 year survival is 62%. When the melanoma has spread to distant organs, then 5 year survival is 15%.
Most melanomas are pigmented lesions. They may occur in both sun-exposed areas of skin as well as skin that is usually covered (including toenails, fingernails). Melanomas can also occur in the eye and gastrointestinal tract. Melanomas, compared with benign pigmented lesions, are more likely to have the following features:
Melanomas are not necessarily pigmented (dark). "Amelanotic" melanoma is a melanoma in which the cancer cells have lost the ability to produce pigment. If melanoma is not suspected, these non-pigmented lesions can go unnoticed and untreated for a long time.
All people should perform monthly total body skin self-examination and have a yearly skin examination by a physician (family physician, dermatologist, surgical oncologist).
Key statistics about melanoma from the American Cancer Society http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-key-statistics
Melanoma website at the National Cancer Institute http://www.cancer.gov/cancertopics/types/melanoma
Siegel R, Naishadham D, Jemal A. Cancer Statistics. CA Cancer J Clin 2013; 63:11-30.
The diagnosis of melanoma is made by biopsy of the suspicious lesion. We recommend either punch biopsy or excisional biopsy because these techniques reveal how deep the melanoma is. The depth or thickness of the melanoma is critical in determining further staging and prognosis.
Once the diagnosis has been made, certain tests will be performed to find out how advanced your tumor is. For melanoma, these tests may include:
The stage of a cancer is a standardized description of how far it has spread. The higher the stage, the further it has spread. Importantly, with increasing thickness of the primary tumor, the likelihood of spread to lymph nodes (and distant organs) increases (see link to Prognostic tools, below). Information required to determine the stage of the cancer includes:
Staging describes three elements of a cancer's spread:
Complete information about the staging of melanoma can be found at the website listed below. However, the essential details are:
Detailed melanoma staging http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page2
Prognostic tools http://www.lifemath.net/cancer/index.html
Our team of physicians, consisting of surgeons, medical oncologists and radiation oncologists, work together to select the treatment strategy that is best for each individual patient.
Chemotherapy (or systemic therapy) is a drug or combination of drugs that are given to kill cancer cells wherever they are in the body. There have been a number of recent clinical trials that have given hope to patients with metastatic melanoma. These trials have used drugs that either stimulate the immune system (ipilimumab, nivolumab) or target a specific mutation (vemurafenib). Other, older drugs include temozolamide and interferon.
Radiation therapy is infrequently used in the treatment of melanoma. It may be used to decrease the risk of tumor recurrence after lymph node dissection.
NCCN Guidelines for melanoma http://www.nccn.org/patients/guidelines/melanoma/index.html
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