Melanoma is a form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.
Melanomas that have not grown deeper than the epidermis are referred to as “Stage 0”. They are usually treated by a surgical wide excision to remove the melanoma and a margin of about 1/2 cm. If the edges of the removed sample contain cancer cells, a repeat excision of the area may be done.
Stage I melanoma is treated by wide excision and its margins. The amount of normal skin removed depends on the thickness of the melanoma, but no more than 2 cm of normal skin needs to be removed from all sides of the melanoma. Wider margins make healing more difficult and have not been found to help people live longer.
Some doctors may recommend a biopsy. This is an option that you and your doctor should discuss to determine if a biopsy is the right choice.
Stage II melanoma is treated by a wide excision. The amount of normal skin removed depends on the thickness of the melanoma, but it should be no more than 2 cm (4/5 inch) around all sides of the melanoma. Because the melanoma may spread, many doctors will recommend a biopsy of you lymph nodes. For some patients doctors may advise treatment with interferon, other drugs or perhaps vaccines to reduce the chance the melanoma will come back.
Stage III melanomas have already reached the lymph nodes when the melanoma is first diagnosed. Surgical treatment required a wide excision along with the removal of lymph nodes. It may be recommend to be treated with interferon or radiation therapy to the areas where the lymph nodes were removed, especially if many of the nodes contain cancer.
Stage IV melanomas are very hard to cure, as they have already spread to distant lymph nodes or other areas of the body. Surgical removal is recommended followed by radiation therapy, immunotherapy, or targeted therapy. The treatment of widespread melanomas has changed in recent years as newer forms of immunotherapy and targeted drugs have been shown to be more effective than chemotherapy.
- You may notice any symptoms in the early stages of melanoma. Skin cancers may be sore, itch or bleed. These skin cancers may start as a new skin growth on unmarked skin and change color, shape, or size. These types of changes are an early sign that the growth is melanoma. But melanoma can also develop in an existing mole or other mark on the skin. Or it may look like a bruise that isn't healing or show up as a brown or black streak under a fingernail or toenail.
- Melanoma can grow anywhere on the body. It most often occurs on the upper back in men and women and on the legs in women. In older people, the face is the most common place for melanoma to grow. And in older men, the most common sites are the neck, scalp, and ears.
What to Expect if Surgery is Required
We will phone in prescriptions for you to have on hand after surgery. We will prescribe a pain reliever and possibly an antibiotic.
You should have nothing to eat or drink after midnight the night before surgery. This includes candy, water, coffee, and gum. If there are any medications that you take on a regular basis and are concerned about taking them the morning of surgery, please call Dr. Cole to discuss this with him.
Dr. Cole may recommend that you see your primary care doctor or other specialists involved in your care to obtain a surgical clearance.
Please bathe or shower prior to surgery. Remove all makeup, jewelry, hairpieces and false eyelashes. Do not use lotions or oils after bathing.
Wear comfortable clothing that is easy to put on and remove.
Dr. Cole recommends bed rest once you arrive home on the day of surgery. Dr. Cole will suggest that you stay indoors and take it easy the first 3 days after surgery. Once Dr. Cole sees you in the office for your 7 day follow up it will be determined the extent of your activities and physical exertion.
•After every surgery there will be swelling, which is a normal tissue response. Bruising may also be seen under the incision. Again, ice will help significantly.
•You may sit on a sofa, or at your desk, but minimize your activity
•No heavy lifting greater than 15 pounds for approximately 6 weeks after surgery
•A ridge of firm tissue will develop beneath your incision. This is part of the normal healing process and will resolve over the next few months
•Massage with Aloe Vera gel for the next 2 – 3 months, 2 – 3 times per day. This will help to break down the scarring process
•Should you develop a fever or the wound becomes very swollen, tender and/or red, contact Dr. Cole immediately
•Please call Dr. Cole the following morning to check-in and make an appointment within 7 – 10 days