Melanoma – An Introduction

Last Updated: October 23, 2020

Melanoma occurs when cells called melanocytes begin to change and grow out of control, and it can form anywhere on the body. In this video, Dr. Ryan Sullivan discusses the stages of melanoma and explains treatment options.    

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Cancer.Net: Doctor-Approved Patient Information from ASCO®

Melanoma – An Introduction

Voiceover: Melanoma occurs when cells called melanocytes begin to change and grow out of control. Common places for melanoma to develop include the face, scalp, back, chest, legs, and arms, but it can form anywhere on the body.

Ryan J. Sullivan, MD; Medical Oncologist; Member, American Society of Clinical Oncology: Typically people think of melanoma as a skin cancer but truly it's a cancer of pigment producing cells and depending on where the the pigment producing cells are that become cancerous, we would say it's cutaneous melanoma or skin melanoma, ocular melanoma or eye melanoma, sometimes also called uveal melanoma, and then mucosal melanoma, which would be melanomas that arise on the lining surfaces of say the mouth or the sinuses or the genitals.

Voiceover: Sometimes melanoma develops from a normal mole a person already has on their skin. When this happens the mole will undergo changes that usually can be seen, such as changes in shape, size, color, or the border of the mole. Melanoma is diagnosed through a biopsy where a doctor removes some tissue for a pathologist to look at under the microscope. Once melanoma has been identified, and a diagnosis has been made, patients should get as much information as possible from their doctor about the stage and other details related to their specific melanoma.

When found in an earlier stage, melanoma can often be cured with surgery. However melanoma is one of the most serious forms of skin cancer, and many factors are considered in making a treatment plan. In its later stages, melanoma can grow deep into the skin, called invasive melanoma. It can also invade lymph nodes and blood vessel and spread to distant parts of the body, called metastatic melanoma. Depending on the results of the biopsy and other factors, further testing for high risk or later stage melanoma may include tests such as ultrasound, CT scan, PET scan, or MRI.

Dr. Sullivan: Staging is a way of of grouping patients into risk levels, and based on risk levels, that's how we decide--based on data--but how we decide which treatments should be offered. And then it helps really frame the discussion about what do we do after the surgical procedure is completed.

Voiceover: The stage will help the doctor determine if further treatment is needed after the surgical removal of the melanoma, also called an excision.

Dr. Sullivan: The standard of care surgical management is either a wide excision or a wide excision with sentinel lymph node biopsy and it just really depends on how thick and aggressive the melanoma looks under the microscopes.

Voiceover: Doctors use the melanoma's thickness, measured in millimeters, and the other characteristics to determine the disease's stage. The stages of melanoma include stage 0, and stages I (1) through IV (4). The stage provides a common way of describing the cancer, so doctors can work together to create the best treatment plan.

Dr. Sullivan: Stage I melanoma: surgery. Which is a wide excision and possibly a sentinel lymph node procedure, depending on the thickness and whether or not there's ulceration or dividing cells under the microscope. Stage II, which is confined locally and not spread to regional lymph nodes, is treated with a wide excision. However you don't know necessarily that you have stage II, until you've had a sentinel lymph node biopsy and harvesting of the sentinel lymph nodes, so that's all 1 procedure. And when that's completed, then we know you either have stage II or potentially stage III with microscopic lymph node involvement.

In the stage III setting, we also encounter patients who have bulky lymph nodes that are diagnosed at the time of presentation. Sometimes maybe the first thing a patient recognizes, say they're in a very common scenario of patients in the shower and they're feeling under their arm and they feel a lump, and then it ultimately leads to a biopsy and says you have melanoma. And so that very commonly is stage III melanoma, and if all the scans have been done which is appropriate to be done when you have either very high risk stage II or stage III, and you've been told there's no other melanoma anywhere else other than that 1 area, then we take out those lymph nodes nearby, and if the primary tumor is also there, we take out the primary tumor.

Voiceover: Surgery is the main treatment for people with local melanoma and most people with regional melanoma. For patients with stage III or stage IV melanoma, there are a number of other treatment options that can be considered, including targeted therapies and immunotherapies.

Dr. Sullivan: The growth in the field over the last decade has been astonishing. After surgery for stage III, a conversation should be had between the patient and a medical oncologist to determine whether or not that patient is appropriate to receive therapy after surgery. We call that adjuvant treatment, and there are a number of adjuvant therapies that have recently been approved by the FDA to treat patients with high risk stage III melanoma. These include targeted therapies and immunotherapies. It's also appropriate in some patients to monitor in that scenario, and not be treated with therapy. And some patients decide that they'll wait if their disease were to spread at a later date and then start therapy in that setting. In the metastatic or unresectable setting, we have all of those same therapies in stage III are also appropriate for stage IV, so we have targeted therapy and we have immunotherapy. So those are the typical therapies that we would give, that can provide treatment for basically most patients.

Voiceover: Chemotherapy and radiation therapy may also be used to treat melanoma in some patients. Treatment recommendations depend on many things, including the thickness of the primary melanoma, whether the cancer has spread, the stage of the melanoma, the presence of specific genetic changes in melanoma cells, rate of melanoma growth, and other factors, such as the possible side effects of the treatment, options, the patient's preferences, and their overall health.

To learn more about melanoma please visit ASCO's patient information website, Cancer.Net.

Dr. Sullivan: For more information on the steps of treatment for melanoma, the staging and diagnosis, as well as trying to understand some of the concepts about how we have come so far and where we're going with therapies for melanoma, I recommend that you go on to Cancer.Net, as well as any family members or loved ones who have other types of cancers.

[Closing and Credits]

Cancer.Net: Doctor-Approved Patient Information from ASCO®

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