Melanoma is a highly malignant skin cancer that begins in melanocytes (cells that make the pigment melanin, which gives skin its color) of normal skin or moles and spreads rapidly and widely. Of the three main types of skin cancer, basal cell carcinoma and squamous cell carcinoma are more common. Melanoma is much less common but melanoma is more likely to spread to other parts of the body (metastasize).
Melanoma can develop anywhere on the skin. For women, it more commonly develops on their arms and lower legs and for men it is more likely to appear on the part of the body between the shoulders and the hips, called the trunk, and their head or neck. Sometimes melanoma may occur even on areas of the skin that are never exposed to sunlight such as in the eye, under a fingernail or toenail, in the nose and sinuses, or in other parts of the body.
If left untreated, melanoma tends to spread quickly to other parts of the body--more than most other types of skin cancer, which makes melanoma more dangerous and somewhat unpredictable. Melanoma tends to spread first to lymph nodes in the area of the original tumor. For example, if the tumor developed on the leg, it may spread to lymph nodes in the groin area. But, sometimes, melanoma may spread to distant areas of the body, such as the liver, lungs, or brain, and even in distant lymph nodes.
Patients with melanoma often require a combination of surgery, chemotherapy, and radiation therapy. Because of this, a coordinated team approach is the best way to manage these complicated cases.
At Brigham and Women’s Hospital (BWH), our surgical oncologists are among the world’s leading surgical specialists treating complex and advanced-stage melanoma. They are the surgical team at the Center for Cutaneous Oncology at the Dana-Farber/Brigham and Women’s Cancer Center.
Working together as one singularly-focused team, we help melanoma patients recover faster with improved outcomes and fewer post-operative complications. From diagnosis to treatment, our multidisciplinary team of surgical oncologists, dermatologists, pathologists, medical oncologists, plastic and reconstructive surgeons and radiation oncologists work collaboratively with patients and families.
In addition dedicated patient coordinators ensure that you understand your care plan and help you set up the appointments with various specialists.
Melanoma starts when normal melanocytes become cancerous. When cancer cells are on the skin, the cancer is called cutaneous melanoma. Most of what we know about melanoma (its behavior, staging, and treatment) refers to cutaneous melanoma.
Types of Cutaneous Melanomas
Melanoma Growth and Spread
If melanoma grows at the site of the original tumor, it tends to grow in one of two ways:
The first symptom of melanoma is usually a change in a mole or the appearance of a new mole that has ABCDE characteristics. These ABCDE rules can help you tell a normal mole from cancer.
The ABCDE rules are:
Your health care provider will examine you with the ABCDE rules in mind (see above) and will ask about the moles on your skin:
Make sure to tell your health care provider if you’ve had skin cancer in the past. Also note whether anyone in your family has had skin cancer.
Your health care provider will likely take a biopsy of any mole or other skin mark that may look like cancer.
The different types of biopsies include the following:
The biopsy and other tests will help your doctor determine the extent of melanoma, called its stage. Melanoma may be located in one specific area of the skin, but it can move quickly to the lymph nodes. Your treatment plan and chance for a good outcome--called the prognosis--depend on the stage of your melanoma. They also depend upon your general health, the location of the tumor, and other factors.
The melanoma surgical specialists at BWH along with their colleagues at the Melanoma Treatment Center at the Dana-Farber/Brigham and Women’s Cancer Center focus exclusively on melanoma treatment and research.
You may have just one treatment, or a combination of treatments.
You will receive a thorough diagnostic examination to evaluate your condition and determine what course of treatment is needed. Careful monitoring and the involvement by an experienced surgical oncologist is important to the successful outcome for patients with advanced or complex melanoma.
If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.
The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with melanoma. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.
The surgical specialists at BWH along with their colleagues at the Melanoma Treatment Center at the Dana-Farber/Brigham and Women’s Cancer Center provide the world’s most advanced and innovative multidisciplinary care for patients with melanoma. Our treatment team includes surgical oncologists, medical and radiation oncologists, plastic surgeons, nutritionists, pathologists and anesthesiologists. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.
Learn more about risk factors for melanoma in our health library.
Read more about melanoma diagnosis in our health library.
Learn more about immunotherapy for melanoma treatment in our health library.
Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.
Visit the Weiner Center for Preoperative Evaluation.
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