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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.

Stage 1. Almost all will survive 5 years
Stage 2. 80 men. 90 women
Stage 3. 50 men 50 women
Stage 4. Statistics may be better with new medicines 10 men 25 women

Also read Balch for further stratification 2008 AJCC data

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.

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

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

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

Current guidance is to offer SLNB for stages IB (MM>1mm) 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

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

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

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