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.
Cancer research UK says (11.2.16) that out of 100 men and women with melanoma the 5 year survival is.
||Almost all will survive 5 years
||80 men. 90 women
||50 men 50 women
||Statistics may be better with new medicines 10 men 25 women
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 your AJCC staging
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
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
No ulceration = a
Ulceration = b
T1a. <0.8mm no ulceration
T1b. 0.8-1.0 mm no ulceration
<or = 1.0 & ulceration
Check out AJCC8
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
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
Foci adjacent to seen on microscopy
Foci clinically within 2cm
In transit met
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
|Stage 0 (LM) -
||At least 0.5 cm
|Stage 1 -
||At least 1cm
|Stage 2 -
||At least 2 cm
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.
But there is a debate about the usefulness of sentinel lymph node biopsy.
Consider the controversy and discussions regarding SLNBx for Melanoma by reading the references below.
Sentinel lymph node biopsy on wikipedia
Morton DL et al. Sentinel node biopsy or observation in melanoma. NEJM 2006 355 1307-17
Morton DL et al. Final trial report of sentinel node biopsy versus observation in melanoma. NEJM 2014 370 599-609
Torjesen I et al. Sentinel lymph node biopsy for melanoma: unnecessary treatment. BMJ 2013 346 e8645
McGregor JM. Too much surgery and too little benefit? Sentinel lymph node biopsy for melanoma as it currently stands. BrJDermatol 2013; 169: 233-5
BMJ 5 December 2105 - editors choice
Sentinel lymph node biopsy in melanoma. BMJ 5 December 2015 (2915; 351: h5940)
McGregor JM, Sasieni P. Sentinel lymph node biopsy in cutaneous melanoma; time for consensus to better inform patient choice. Br J Dermatol 2015; 172: 552-4
CancerResearchUK summarises the situation as
"It is not a treatment for the melanoma itself. At the moment it is still unclear how useful it is to do a sentinel node biopsy.....there is no evidence that removing the lymph nodes will help you live longer. So not all hospitals offer these tests."
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
Access to immunotherapy
Timing of procedure
Seroma / Haematoma
Returning to driving
Who will follow you up for immediate side effects/ complications
Who will follow undertake long term follow up
Measurement of Vitamin D should be undertaken in secondary care in all people with MM
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
Organising the practical
Support Helpline offer from Melanoma Focus
Also check out on Google
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