Advanced Surgical Treatment for Melanoma

What is Melanoma?

When people think of skin cancer, they immediately think of melanoma, the most serious type of skin cancer. Melanomas form when UV-damaged skin cells mutate, causing the cells to quickly spread and multiply, resulting in the formation of life-threatening cancerous tumours. These cancerous growths develop in the basal (innermost) layer of the skin. Melanoma skin cancers typically bear resemblance to ordinary moles, with some melanomas even forming from moles.

Melanomas vary in colour, ranging from darker hues such as brown and black, to lighter shades such as white, pink, blue, purple or red. Melanoma is most often attributed to bouts of exposure to extreme UV radiation over the course of a person’s lifetime and is more prevalent among people with a fair complexion and light eyes.

Although melanomas are extremely dangerous, early detection and treatment typically ensures that they can be successfully removed. In cases where they can’t be treated, the melanomas will often metastasize (spread to other regions of the body) where they can become difficult to remove, potentially resulting in the death of the patient. According to Melanoma Institute Australia, melanoma is the 4th most common form of cancer in Australia, with a person dying every 6 hours from this lethal disease.

Melanoma Treatment

At Skin Clinic Robina, we’re specialists in the diagnosis and treatment of melanoma skin cancers. The method of surgery we choose to employ to remove the cancerous tumour is based on a number of key factors, such as the result of the biopsy report, the location and type of melanoma detected and the risk that the cancer will spread. All early stage melanomas are removed using surgical excision and this is typically sufficient to eradicate the cancerous tissue entirely.

To minimise the chance of biopsy-proven melanomas reforming at the same location of the original tumour, a ‘wide local excision’ is usually performed. This involves the removal of the cancerous tissue, along with a portion of healthy skin cells located around the outside of the tumour (known as a safety margin). When a melanoma has progressed to an advanced stage and spread to other parts of the body (metastasized), we will refer them to the melanoma clinic in the Princess Alexandra Hospital or the Gold Coast University Hospital.

How Long Does the Treatment Procedure Take?

All surgical treatment is performed under local anaesthetic and the entire operation takes around 30 minutes to complete for smaller melanomas, with the subsequent wounds healing within a couple of weeks. In cases where the surgical wound cannot be adequately sutured together, a skin flap or skin graft may be required to seal the wound. The degree of scarring varies, and depends on the size and location of the melanoma removed and the patient’s post-operative care of the resulting wound.

Melanoma Warning Signs

While ordinary moles, spots and other skin growths are common and are often innocuous, there are exceptions. The first warning signs can manifest themselves upon irregular moles. When examining your skin for possible melanomas, basal cell carcinomas or squamous cell carcinomas, it’s extremely important to examine your skin regularly, taking careful notice of particularly conspicuous moles to ensure that any alterations in appearance can be quickly identified.

When examining your skin for suspicious growths or moles, it’s important to be aware of the following:

Shape – ordinary benign moles will typically be symmetrical, whereas malignant melanomas will not.

Border – ordinary moles have smooth, distinct borders, while melanomas typically have loosely defined ones, giving them a blotchy and uneven appearance.

Colour – normal moles are generally a single colour and are most commonly brown. When a mole contains multiple colours, this can signify the presence of a melanoma. Over time, the cancerous growth may become white, red or even blue.

Size – benign moles are often smaller than malignant melanomas, which are generally larger than 6mm. (The can be smaller than this when initially discovered)

Mutation – ordinary moles do not change over time, while malignant moles undergo mutation, resulting in alterations to their key characteristics, such as the ones alluded to above. Additionally, they may become itchy, develop a crusted surface and/or bleed from time to time.

TYPES OF MELANOMA

There are four main categories of melanoma; superficial spreading melanoma, lentigo maligna, acral lentiginous melanoma and nodular melanoma.

Superficial spreading melanoma – the most prevalent form of melanoma, the malignant tumour develops along the outermost layer of the skin, where it remains for some time, before eventually permeating deeper into the skin. These melanomas most commonly occur in younger generations and display the characteristics listed in the ‘warning signs’ section, such as non-uniform shape, indistinct border and variable colour. These forms of melanoma can develop from existing, previously innocuous moles, once again highlighting the importance of regularly checking the moles across your body.

Lentigo maligna – like the superficial spreading melanoma, lentigo maligna tumours reside on the outer layers of the skin for a considerable amount of time, and are often brown in colour, with a flat or slightly protruding surface. Lentigo maligna is most commonly found among older generations.

Acral lentiginous melanoma – although residing on the outer layers of the skin prior to penetrating deeper beneath the surface, like that of the superficial spreading melanoma and lentigo maligna, acral lentiginous melanoma is unique in that it typically develops under a person’s nails, on the palms of their hands or on the soles of their feet. In other words, the melanomas form on areas of the body that aren’t exposed to direct sunlight.

Nodular melanoma – unlike the other categories of melanoma, nodular melanomas form within the deeper layers of the skin to begin with, and are most commonly black in colour, although in rarer cases they can also be red, white, brown, grey or blue. Nodular melanomas are the most aggressive and therefore, most dangerous type of melanoma and occur most often among the elderly.

WHO IS AT RISK OF DEVELOPING MELANOMA?

While literally anyone who has ever spent time in the sun and been exposed to ultraviolet radiation during their lifetime is at risk of developing melanoma, there are a host of different factors that increase the likelihood, such as:

• The degree of cumulative sunburn experienced
• The use of tanning beds
• The number of moles you have on your body; melanomas can form from ordinary, previously benign moles
• Your skin type; people with fair skin are more susceptible to developing melanoma and other forms of skin cancer such as basal cell carcinoma and squamous cell carcinoma
• Your skin cancer history; if you’ve had skin cancer before, there’s an increased likelihood that the skin cancer (including melanoma) will reappear again
• Your immune system; people who have a depleted immune system, as a result of a medical condition or disease, are more likely to develop melanoma
• Family history; if someone in your family has had a melanoma removed, you are at a far greater risk of developing melanoma, as well

TREATMENT

At Skin Clinic Robina, we provide a range of effective melanoma treatments at our Skin Cancer Clinic, including:

• Surgical removal/excision – this involves numbing the skin tissue using a local anaesthetic. The cancerous and surrounding normal tissue is then removed using a surgical scalpel.
• Flap surgery – flap surgery is required when the size of the wound created by the skin cancer’s removal, is too large to stitch together. A skin flap made of healthy skin or tissue beneath the skin (subcutaneous) is removed from an area of the body, and transferred to the site of the wound where the skin cancer was extracted. This patches and covers the area of the wound.
• Graft surgery – this is similar to flap surgery, except the tissue extracted from the healthy donor site of the body, relies on the blood supply of the wound created by the skin cancer’s removal.
• Slow MOHS technique – while this treatment method concerns the surgical excision of the skin cancer, Slow Mohs surgery may require multiple treatment sessions. When the skin cancer has been removed, the extracted cancerous tissue is sent to a lab for analysis. If results indicate that the tissue contains cancer around the margins of the sample, then additional tissue will be removed, and the sample is sent to the lab once more. This is done until the margins around the sample are identified as non-cancerous.

MELANOMA PREVENTION

Not only is Queensland the ‘Sunshine State’, it also happens to be the skin cancer capital of the world. According to Cancer Council Queensland, over 3,600 people living in Queensland are diagnosed with melanoma each year, while a staggering 350,000 non-melanoma skin cancers are treated during this same time period. For this reason, it is essential that people incorporate a list of sun smart strategies to abide by, when venturing outdoors, such as:

Always try to minimise your sun exposure between the hottest hours of the day; 10 AM – 4 PM

• Wear a wide-brimmed hat and (ideally) sunglasses with UV-protective lenses
• Do not use tanning beds
• Use sunscreen with an SPF of at least 30 (50 is recommended)
• Always apply sun cream to your body, approximately half an hour before you head outside and again every 2 hours thereafter or immediately after you’ve been in the water
• Always keep infants out of direct sunlight
• Aim to see a skin doctor at least once a year, for a skin check. (your frequency of visits should be based on the amount of time you spend outdoors, your skin complexion and your skin cancer history)

CONTACT SKIN CLINIC ROBINA

Melanoma is the most serious form of skin cancer and can rapidly spread to other parts of the body, if left untreated. However, if detected early, it can almost always be treated successfully. Arrange for a skin check today, with one of our trained specialists at Skin Clinic Robina, the Gold Coast’s premier melanoma treatment clinic.