Malignant Melanoma

What is a malignant melanoma?

Malignant melanoma (MM) is the rarest, but the most serious of all skin cancers. There has been a sharp rise in numbers over the last decade and it accounts for around 9,000 new cases each year.

It is a cancer of the melanocyte cells, which produce the brown pigmentation in your skin that forms freckles, moles, and your suntan. They are found at the base of the epidermis (the top layer of your skin). MM’s appear in normal skin or in changing moles.

Suspicious changes include:

• an increase in size or change in shape
• deepening in colour
• itching, bleeding and surrounding
  inflammation

They can spread along the skins surface but they can also penetrate inwards to the deeper layers of the skin. This is when, if left untreated, they may spread to other areas of your body. If any of the melanoma cells have broken away they can spread to your lymph glands (also called nodes).

You have lymph glands all over your body; there are large groups of them in your neck, jaw, axilla (armpit), elbow creases, groins and behind your knees. If the melanoma has spread it will generally travel to the nearest group of nodes from the original site and if this happens you will need to have all the glands in that area removed, this is known as a “block dissection”.

What are the causes?

The cause of melanoma is not entirely understood but there is strong evidence to suggest that ultraviolet radiation caused by exposure to high intensity sunshine (causing the skin to burn) is a major factor. People with fair or red complexions are particularly at risk especially if they have been sunburnt during childhood and early adulthood.

A small group of people may have genetic predisposition to the development of melanoma and the use of sun beds is also thought to increase the risk of developing skin cancer.

How are they treated?

Treatment of malignant melanoma depends largely on the result of your biopsy which usually involves close but complete excision of the mole and will tell us how thick your melanoma is (the Breslow thickness).

Following your biopsy you may need to have another operation called a “wide local excision”. If your melanoma is 1mm or more thick you may be offered a test and minor operation called a “sentinel lymph node biopsy”.

In some cases you will be asked to have other investigations to find out if there has already been any spread of your melanoma.

You will be given the results of your tests and the outcome of your surgery approximately two weeks afterwards at an outpatient appointment.

Lentigo maligna (a form of malignant melanoma in situ) is not always treated with surgery, because it has not penetrated into the deeper layer of the skin it can sometimes be treated with radiotherapy or chemotherapy creams.

Follow up care

Malignant melanoma is more easily treated if diagnosed early.

You will need to be seen on a regular basis by your Consultant or Specialist Nurse. You will be informed in the clinic what your follow-up schedule will be.

At your follow up appointments in the outpatient department your melanoma site will be examined for signs of recurrence and your lymph glands will be examined for signs of enlargement. You will be shown what to look for in your melanoma site and how to examine your own lymph glands by your nurse specialist.

Vitamin D advice

The evidence relating to the health effects of serum Vitamin D levels, sunlight exposure and Vitamin D intake remains inconclusive. Avoiding all sunlight exposure if you suffer from light sensitivity, or to reduce the risk of melanoma and other skin cancers, may be associated with Vitamin D deficiency.

Individuals avoiding all sun exposure should consider having their serum Vitamin D measured. If levels are reduced or deficient they may wish to consider taking supplementary Vitamin D3, 10-25 micrograms per day, and increasing their intake of foods high in Vitamin D such as oily fish, eggs, meat, fortified margarines and cereals. Vitamin D3 supplements are widely available from health food shops.

Ref: 15-17-112
Review: 11/19