Q: I was diagnosed with Stage II melanoma. How is this treated?
A: Melanoma is an aggressive form of skin cancer, often caused by damage from prolonged exposure to ultraviolet rays. This type of damage can potentially lead to growth of cancerous cells, forming tumors on or under the skin. Tumors on the skin tend to resemble moles and are referred to as melanomas.
Several factors can lead to an increased risk of developing melanoma. While certain factors, such as family history and fair complexion (blond hair and blue eyes), are unavoidable, others are controllable, such as excess exposure to ultraviolet rays (through direct sunlight or tanning beds).
To determine the most effective treatment options for each patient, physicians examine melanomas and classify them using the TNM system, which stands for:
Tumor. Assessment of tumor thickness and presence or absence of ulceration, which is the breakdown of skin around the melanoma.
Nodal status. Testing to identify whether the cancer has spread to the lymph nodes closest to the melanoma.
Metastasis. Analysis of test results to determine whether the cancer has spread to vital organs, such as the brain and lungs.
Thanks to increased patient awareness and better adherence to preventive measures, physicians are treating the early stages of melanoma, such as Stage II, more frequently, when treatments are often more effective. Stage II melanoma includes melanomas at least one millimeter in thickness with or without ulceration that has not spread to the lymph nodes or other sites of the body.
Treatment recommendations depend on the thickness of the melanoma and the presence of ulceration. Melanomas less than one millimeter in thickness are referred to as thin melanomas. Melanomas between one and four millimeters are categorized as intermediate-size melanomas, and those greater than four millimeters are considered thick melanomas.
Biopsy of a melanoma is a common first step in the surgical process. A pathologist will measure the tumor thickness and determine whether additional surgery is necessary. Your physician may also perform a sentinel lymph node biopsy to see whether the cancer has spread to nearby lymph nodes.
Within the last 10 years, doctors have made substantial breakthroughs with new medications for treatment of melanomas. Certain medications are paired with surgery, while others may remove the need for surgery entirely.
For example, immunotherapy is a relatively new type of treatment that focuses on strengthening the patient's immune system, preparing it to fight off cancerous cells. Thus far, immunotherapy has shown very promising and durable results in the treatment of melanoma. Your immune system has a greater chance of identifying and attacking cancerous cells when functioning at its best.
Early detection and highly effective treatment options for melanoma have led to higher survival rates among those diagnosed with the disease. On average, there is a 99 percent survival rate among people with Stage I melanoma and an 80 to 90 percent survival rate among those with Stage II melanoma.
Pay attention to early signs of melanoma. When you notice a new blemish on your skin, look out for any growth or changes that may occur. Routine check-up appointments and screenings are crucial in monitoring skin health, especially for those with a high risk of developing melanoma. Talk to your physician to take a proactive approach in identifying potential risk factors for melanoma.
Unfortunately, even melanomas that were initially treated can relapse several years later, so it is crucial to commit to a lifetime of follow-up and surveillance to ensure early detection.
Carmine Volpe, M.D., FACS, is the medical director of Mercy Health Cancer Center.