Melanoma Diagnosed

I'm sorry that you've been diagnosed with a melanoma.
Here's some information that might help.

Check out Melanoma: assessment and management NICE

Melanoma: Summary of NICE guidance 29.7.15 BMJ

I am often asked What's my long term outcome?

This depends on a lot of variables but the Breslow thickness (thickness of the melanoma) is one of the most important factors.

Statistics are often quoted depending on your stage.

MM survival

Cancer research UK says (11.2.16) that out of 100 men and women with melanoma the 5 year survival is.

Q. So - What is my melanoma stage? / Stage / Staging of Melanoma

If you have had a mole cut out and it is shown to be a melanoma then you will have a stage (be staged).

Melanoma management is based on AJCC staging 8

This can sometimes be practically complex and requires several items of clinical and histological information. Check out Melanoma UICC TNM 8

You will probably need further removal to reduce the risk of recurrence.

Staging can be confusing
To simplify

Ask;
Have you got distant mets
Yes - stage IV

Have you got nodes
Yes - stage III

What is your Breslow thickness and ulceration status as this will place you in stage IA. IB. IIA. IIB. IIC

Generally speaking
No ulceration = a
Ulceration = b

T1a. <0.8mm no ulceration
T1b. 0.8-1.0 mm no ulceration
        <or = 1.0 & ulceration
T2 1.1-2
T3 2.1-4
T4 > 4 mm

Check out AJCC8

Previously

T1 was <1 mm
T1a <1mm, non-ulc and no mitosis
T1b <1mm, ulcerated or mitosis

AJCC 8 Melanoma drops mitosis rate and lists
T1a as <0.8 mm & non ulcerated
T1b is <0.8 mm & ulcerated or
           0.8-1.0 mm

The tumour will be rounded to the nearest 0.1mm

Regional Lymph Node
This has become more complex under AJCC 8

Micrometastasis now replaced by
Clinically occult disease as detected by Slnbx

Macrometastisis now replaced by
Clinically detected disease

III has 4 stage groups not 3 i.e. IIID

N1c N2c N3c
Microsatellite
Foci adjacent to seen on microscopy

Satellite metastasis
Foci clinically within 2cm

In transit met
>2cm

M distant metastatic disease

Medicine is always changing with new data available so do check up to date statistics but to help - some outline figures -----
For stage 1A
Slnb probably only 7% positive

For stage IB and beyond
0.8 mm & ulcerated
SLNBx probably 35% positive (i.e. Upgraded to Stage III --> imaging & possible oncologic immunotherapy)

(Ulcerated tumours behave like non-ulcerated tumours of the next category)

Q. How much will I need cutting out?

Current suggestion is here

If histologically clear, the excisional biopsy margin may be added to the WE surgical margin for definitive surgical excision (Swetter S et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2019 80 208-50)

Q. Do I need a sentinel lymph node biopsy (SLNBx).

Current guidance is to offer SLNB for stages IB (MM>0.8mm) to IIC

The sentinel lymph node is the first lymph node to which melanoma may spread.
If you have been diagnosed with an intermediate thickness malignant melanoma (Breslow thickness 1-4mm) then you may wish to discuss SLNBx.

This is currently a staging procedure which takes place under general anaesthetic by a plastic surgeon not a dermatologist. It is a specialised service that is only available in certain centres with expertise. Click here for Oxford's patient information leaflet.

You may need to read further and wider and to ask questions to work out whether it is of benefit to you. Currently SLNBx has not been shown to prolong survival but it does accurately stage an individual. This may in turn open up access to treatments or entry into research and clinical trials.

You will need to decide if the benefits of knowing your stage accurately are important to you. Balance this against possible risks from the procedure and factor in time taken to have the procedure and recovery time.

Should you decide that a SLNBx is important for you, then you will need to consult a plastic surgeon who carries out the procedure. Consider asking about the Pros & cons;

Benefits to you

Accurate staging
Access to immunotherapy
Timing of procedure

Risks

Lymphoedema
Seroma / Haematoma
False positive
False negative

Ask about

Returning to driving
Who will follow you up for immediate side effects/ complications
Who will follow undertake long term follow up

Predicting SLN status using nomograms

Melanoma institute Australia

Memorial Sloan Kettering Cancer Centre

Vitamin D

Measurement of Vitamin D should be undertaken in secondary care in all people with MM

Follow up

IA 1 year (3/12 x 4)

All others 5 years (3/12 for 3 yrs then 6/12 for 2 yrs)

This Melanoma "Pack" may be useful to you

Macmillan have very helpful support and information

Understanding melanoma treatment with surgery

Melanoma

Organising the practical

SLNBx Oxford

Support Helpline offer from Melanoma Focus

Also check out on Google
Changing faces
Sun protection guidelines
Self skin exam Holistic needs assessment

Wessex - guide to Melanoma

Holistic Needs Assessment

Wessex - how to check lymph nodes

Macmillan money worries help