Melanoma

What is a melanoma?

Melanoma is a type of skin cancer that arises from pigment cells (melanocytes).  Although it is not the most common skin cancer, it is one of the most serious and Australia and New Zealand have the highest rates of melanoma in the world.

What is the cause of melanoma?

The main cause of all types of skin cancers is exposure to ultraviolet radiation from the sun or another source (e.g. solarium tanning machine).  Repeated overexposure to UV radiation permanently damages the skin and ultimately the skin cells can transform into cancer.  A small proportion of patients who develop melanoma also have a genetic predisposition.

Risk factors for melanoma include:

• Skin type
• Having lots of moles
• Childhood suntanning/sunburn
• UV exposure
• Age
• Family history of melanoma

Difference between a benign mole and a melanoma

Melanoma can vary greatly in the way it looks. The first sign of a melanoma is usually a new spot or a change in an existing mole.

• Size - The spot may start to enlarge
• Colour - There mole may become increasingly blotchy with variation in the shade of colour
• Borders - Irregular edges or asymmetry
• Itching or bleeding
• Elevation - the mole becomes raised in certain areas

All adults who develop new moles should see their doctor and get it examined.  Even if you have had a mole checked before, keep an eye on it.  With modern smartphones it is quite easy to take a photo and spot any changes in the mole over time.

I’m worried I have a melanoma

The first thing is to get a medical examination by your doctor.  If they suspect a particular spot on your skin may be a melanoma, the usual procedure is to prove this by performing a procedure called a biopsy.  This is generally a quick and simple procedure done under a local anaesthetic.  It is generally recommended the entire mole is excised and examined under a microscope by a pathologist to confirm the diagnosis.  For particularly large moles or moles in specific locations (ear, nose) sometimes only some of the mole is biopsied for testing.

Staging a melanoma

Once a melanoma has been diagnosed, you may need to undergo further tests to know extent of the cancer.  Depending on the characteristics of the melanoma, this may be as simple as a clinical examination or may involve further scans or even surgery.

Surgery to treat melanoma

Wider excision

Most patients with melanoma will need to undergo a wide local excision.  This involves removing the melanoma with a rim of normal skin as a “safety margin”.  The aim is to improve the chance that all cancer cells have been cut out.  The extent of the safety margin depends on the characteristics of the specific melanoma.

Depending on the location of the wider excision and amount of additional margin needed, sometimes a skin graft or a local flap may be required to close the defect left by the excision.
A skin graft involves removing a thin layer of normal skin from a healthy part of the body (typically thigh, inner arm) and placing it over the gap created by the melanoma excision.

A local flap involves transferring local tissue of the same texture and thickness from around the operative site into the defect.  It is often used on the face.

Sentinel lymph node biopsy

For some patients, a sentinel lymph node biopsy is recommended to determine if the melanoma has spread to the regional lymph nodes.  This decision is made based on the characteristics of the melanoma and the perceived risk of lymph node spread.  Sentinel lymph node biopsy can identify microscopic deposits of melanoma which can not be picked up by conventional imaging.  Sentinel lymph nodes are the first few lymph nodes into which a tumour drains.  Sentinel lymph node biopsy involves injecting a tracer material that helps the surgeon locate the lymph node(s) during surgery. These nodes are are removed and analysed under a microscope by a pathologist to look for cancer cell spread.  If the sentinel nodes are free of cancer, then the cancer is unlikely to have spread and removing additional lymph nodes is unnecessary.  If cancer cells are identified in the sentinel node, then it is normally recommended that further lymph nodes be removed to determine how far the cancer has spread in that region.

Stage 3 and 4 melanoma

Once melanoma has spread from the original site to distant skin sites, lymph nodes or internal organs, it becomes a disease which crosses specialties and requires a multidisciplinary treatment approach. This may involve surgery, radiotherapy, immunotherapy, targeted therapies and/or chemotherapy. All our patients with advanced melanoma are discussed at the Westmead Melanoma Multidisciplinary Meetings. This gives our patients the comfort that they are provided up-to-date, evidence based treatment and the opportunity to access new clinical trials as they become available.

Skin Cancers

Skin cancers occur when the cells of the skin are damaged, typically by exposure to UV radiation from the sun or solarium. Skin cancers are by far the most common type of cancer diagnosed every year.  2 in 3 Australians will be diagnosed with skin cancer by the time they turn 70. The three main types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma.

How to check for skin cancers?

Skin cancers that are identified early can often be treated successfully.  However if left untreated, skin cancers can be fatal. We recommend you become familiar with the look of your skin so you can pick up any changes early.  Most skin cancers are discovered by patients themselves or a family member.

Tips for checking your own skin:

1. Find a room with good lighting and a full length mirror
2. Undress completely and check your skin, body part by body part, until you have checked your whole body
3. Ask a family member to help check difficult to see areas (e.g. back)

Look for:

1. Crusty, non-healing sores
2. Small lumps that are red, pale or pearly in colour
3. New spots, freckles or any moles that change in colour, thickness or shape over a period of weeks to months (especially if these spots are dark brown to black, red or black-blue in colour)
4. Be aware of any lumps in your neck, armpits and groin.

If you have any concerns, please check with your doctor for a medical opinion as soon as you can

I have been diagnosed with a skin cancer

Fortunately, the majority of non-melanoma skin cancers can be treated provided they are identified early enough.  Your doctor may perform a biopsy (procedure to remove a sample to tissue for examination under the microscope) to confirm the diagnosis.  They will then discuss with you the treatment options or refer you to see a specialist for treatment.

Do I need to have surgery?

Depending on the type of skin cancer, size, location and your fitness for surgery, your doctor will discuss with your the most appropriate method of treatment.  Surgery is often the simplest way to treat a skin cancer but there are other options including radiotherapy, chemotherapy ointments and cryotherapy.

For advanced skin cancers, particularly those with lymph node involvement, treatment is often a combination of surgery followed by radiotherapy.

Soft tissue tumours

What are soft tissue tumours?

Soft tissue is the name for all the supporting tissues in the body apart from the bones and skin linings.  They include fat, muscle, nerves, blood vessels and connective tissue in the deeper layers of the body.  Soft tissue tumours are tumours (abnormal growths of tissue) which are made up of cells which look like soft tissue types under the microscope, and are named accordingly.  There are over 100 types of soft tissue tumours and they can be either benign (non-cancerous) or malignant (cancerous).

The most common benign soft tissue tumour are lipomas, which are composed of fatty tissue.  But even benign soft tissue tumours vary in how they look and behave.  Some can be quite aggressive and the more the tumour has invaded the nearby tissues, the harder it is to remove completely surgically.  This in turn increases the risk of the tumour recurring despite appropriate treatment.

Malignant tumours of the soft tissue are called sarcomas and need to be treated with great caution.

What symptoms do they cause

In their early stages, soft tissue tumours often don’t cause any symptoms.  As they become bigger, you may notice a painless lump and once it becomes large enough to cause compression of adjacent structures, you may begin to have pain.  Other symptoms are often related to the location of the tumour.

Diagnosis

It is important to accurately identify the nature of the tumour.  If it is malignant, treatment is quite different from a benign tumour.  Imaging techniques like MRI can be used to better define the characteristics of soft tissue tumours and CT scans or PET scans may be used to determine if the tumour has spread elsewhere.  With the exception of small lumps that are classic for lipomas or epidermoid cysts on clinical examination, a biopsy is often necessary to confirm the diagnosis prior to treatment.

Treatment

Best treatment for benign soft tissue tumours depends on the type of tumour, its location and any symptoms it is causing.  For tumours which are not dangerous, often they just need to be watched.  More aggressive benign tumours or symptomatic tumours may be removed with surgery.

Sarcomas usually require aggressive treatment.  High grade tumour are treated with a combination of radiotherapy and/or chemotherapy and surgery to improve cure rates.  Low grade tumours may sometimes be treated with surgery alone.  The aim of surgery is to remove the tumour with a rim of normal tissue around it to ensure the entire sarcoma has been removed, while aiming to preserve important nearby blood vessels, nerves, muscles and bone.