Dear Doctors: My sister-in-law is 82 years old and was recently diagnosed with melanoma. She has an appointment for treatment in a couple of weeks. I thought this was a serious and deadly disease. Can a patient wait long periods of time before treatment? I am surprised by the lack of alarm in this case.
Dear Reader: You are correct that melanoma, which is a form of skin cancer, is potentially deadly. This is due to how quickly this cancer grows and how aggressively it can spread. Although melanoma accounts for just 1% of all skin cancers, it causes the majority of deaths from skin cancer. The good news is that, when it is caught early, melanoma is highly treatable. The data show that the five-year survival rate in people with localized disease, which has not spread to nearby lymph nodes, is 99%.
For those who are not familiar, melanoma develops in cells known as melanocytes. These are specialized cells that produce a brown pigment known as melanin. Melanocytes are found in several areas throughout the body. This includes the skin, hair follicles and the iris of the eye, where they contribute to coloration. Melanocytes can also grow in clusters, forming moles that can appear anywhere on the body. The majority of moles are benign. However, a small percentage can develop cancerous cells.
When melanoma is suspected, something known as an excision biopsy is performed. This is the surgical removal of the cancerous area, along with a margin of surrounding tissue. It is possible, when a lesion is too large or is poorly situated, that just a portion of the tissue will be removed. If it appears that the melanoma has begun to metastasize, or spread, a test of the cells in the nearby lymph nodes, known as fine-needle aspiration, will also be performed. The tissues that have been collected are then sent to a lab to be examined by a pathologist under a microscope.
To know if the speed at which your sister-in-law is being treated is appropriate, information about staging is needed. This is a system used to identify the severity of the disease. For melanoma, stages indicate the depth to which the cancer has penetrated the skin, whether it has spread beyond the original site and, if so, how far it has spread. Staging begins with “melanoma in situ,” or Stage 0. This is cancer that is confined to the topmost layer of the skin. It escalates to Stage 4, which is disease that has spread to distant areas of the body.
For melanoma in situ, treatment consists of the excision biopsy used to diagnose the condition, which completely removes the diseased tissue. If the cancer has penetrated deeper layers of skin, a follow-up excision, along with the removal and examination of nearby lymph nodes, is likely to be scheduled. With metastatic disease, radiation, chemotherapy or immunotherapy are typically recommended.
If you are concerned that your sister-in-law is not receiving speedy care, urge her to gather her medical records and seek out a second opinion from a dermatologist or oncologist with a specialty in melanoma.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
