Fellowship-Trained & Board Certified Dermatologist, Dr. Joel Sears, Answers your top Questions on Melanoma Skin Cancer

Many of us are hesitant to talk about our health and discuss with others what we are or are not doing about it. Skin cancer is a perfect example. According to the Skin Cancer Foundation, skin cancer is the most common cancer in the United States and worldwide. One in five Americans will develop skin cancer before the age of 70.

You need to be aware of three main skin cancers – basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. We have previously discussed the first two (read our blog here) and would like to dedicate this blog to giving you specific information about melanoma. This is especially important since it is the deadliest of the three, and early diagnosis is critical.

What is Melanoma?

Throughout our skin, we have cells called melanocytes that produce brown pigment, like when we tan. Typically, these skin cells grow and develop in a systematic and controlled manner. Healthy new cells push the older cells toward the skin’s surface, where they die and eventually fall off. When one of these melanocyte cells develops DNA damage, they begin to grow out of control and can turn cancerous – that is called melanoma skin cancer. 

The problem with melanoma is that if it isn’t caught and treated early, this cancer can spread to lymph nodes and throughout the body, becoming life-threatening.

Diagnosing Melanoma Skin Cancer

Melanoma is typically spotted on the skin as a new or changing, irregular, brown to black spot. Sometimes it can appear pink or grey-blue in color. The keyword is change. If you notice any new spot or an old mole that begins to change in appearance, you should have it evaluated by a Dermatologist. Melanoma can occur anywhere on the body, including the face, arms, legs, or trunk. It can even happen between our toes or under the finger/toenails and the bottom of our feet.

Health care professionals often identify melanomas at routine checkups, but more and more patients recognize suspicious moles when doing self-skin exams. It is essential to thoroughly examine your skin approximately every month. Get to know your skin well enough so that if there ever is a changing lesion, you’ll be able to recognize it right away.

Melanomas are diagnosed in a Provider’s office by taking a biopsy of the suspicious lesion. The skin sample is sent to a lab, processed, and then looked at under a microscope by a doctor called a dermatopathologist. The dermatopathologist diagnoses cancer when the tissue cells appear to be growing erratically in areas where they are not supposed to be, and the individual cells are abnormal in their number, size, and shape.

When diagnosed with melanoma, the most important finding from a lab report is how thick the melanoma has invaded into the skin. This measurement is referred to as the “Breslow thickness.” The thicker and deeper the tumor grows into the skin, the more potential there is to spread in the lymph nodes or bloodstream allowing cancer cells to lodge in other organs of the body like the liver, lungs, or brain.

What are the Different Stages of Melanoma?

Like many other cancers, melanomas are assigned a clinical stage depending on three factors: 

  1. The thickness of the melanoma as reported in the initial biopsy pathology report (Breslow thickness.)
  2. Has the melanoma spread to a lymph node?
  3. Has the melanoma metastasized to distant organs? 

Pathologic stages range from “0” to “IV” in Roman numerals. The higher the stage, the more severe the melanoma.  Melanomas typically start in the very surface layer of skin called the epidermis. When caught and treated early, melanoma cancer cells can remain within this surface skin layer, and almost all are cured without serious consequences. This would be Stage 0. If the melanoma has grown slightly deeper into the skin but hasn’t spread into the lymph nodes, the tumor is assigned Stage I or II. If the melanoma is found in lymph nodes and/or the cancer has spread to distant organs, such as the lungs or liver, it’s considered Stage III or IV.

Once Diagnosed – What are the Treatment Options?

Fortunately, most melanomas are caught early when they are thin and still on the epidermis, allowing for surgical removal under local anesthesia. Surgical excision remains the mainstay of melanoma treatment. 

When the melanoma occurs on the face or neck, Mohs Micrographic Surgery is often used to clear the tumor and optimize the post-op wound scar. This advanced surgery allows your Fellowship-Trained Mohs Surgeon to microscopically examine and remove all the cancerous skin cells while keeping as much of the healthy tissue as possible. 

Over 95% of melanomas can be cured with surgery alone when caught in the early stages of cancer.

When melanomas have grown deeper into the skin, sentinel lymph node biopsy (SLNB) may be recommended along with the surgical excision. This procedure allows the surgeon to identify the lymph node(s) that the melanoma cancer cells would most likely drain to. Once identified, that lymph node can be removed during surgery and tested for cancer cells. This would be vital information for cancer staging and future treatment options. 

If melanoma has already spread to other organs of the body, the patient is referred to medical oncology and possibly radiation oncology for further treatment. Metastatic melanoma treatment has dramatically improved over the last decade or two with the addition of immunotherapy to our armamentarium of techniques to battle melanoma. The American Cancer Society defines immunotherapy as the use of medicines to help a person’s immune system recognize and destroy cancer cells more effectively. What was often a death sentence has now become a manageable disease, prolonging life in invaluable and meaningful ways.

What happens after treatment?

Once a patient has been diagnosed and treated for melanoma, they will need checkups for the rest of their life. Follow-up visits are needed for surveillance in case of recurrence of the cancer, but statistics also show that once you’ve had one skin cancer, you are more likely to have a second new skin cancer. For the very thin melanomas, follow-up visits may range from every 6 to 12 months.  More invasive melanomas will usually require follow-up visits every 3 to 6 months for five years, then annually if no further problems arise. Full Skin Exams, including lymph node exams, can be expected, along with reminders to practice essential sun protection.

If you would like more information about skin cancers, have concerns about something on your body, or if you have been diagnosed with skin cancer, please make an appointment to come in and see one of our compassionate, highly-experienced Board-Certified Dermatologists and Fellowship-Trained Mohs Surgeons at Advanced Dermatology & Skin Surgery. We have four Greater Spokane and Inland Northwest area locations that are ready to assist you. Book an appointment today.

About the Provider

Dr. Joel Sears, MD, FAAD, FACMS – Fellowship-Trained Mohs Surgeon, Board-Certified Dermatologist – Dr. Sears founded Advanced Dermatology & Skin Surgery back in 1991. He has a passion for helping patients with skin cancer as well as facial plastic surgery. Dr. Sears splits his time between our Spokane and Coeur d’Alene offices.