My sister has melanoma. Please educate me.

Factual Questions
1

I learned from my sister today that she has been diagnosed with melanoma. She will next be undergoing what she’s expecting to be a rather mild outpatient surgery. This is scheduled for Tuesday.

The few details I know are these. She is 51. she noticed a new mole on her ankle about six months ago. She saw her primary doctor who wasn’t very concerned but referred her to a dermatologist. They gave her an appointment five months out which turned out to be last week. A physical exam turned up two more “areas of interest”, and they took three small but painful chunks out of her leg to biopsy. The ankle mole turned out to be melanoma, the others not.

The doctor told her that, statistically, her circumstances put her at the very top on odds for a successful outcome. It was new and small. So small in fact, that they were unable to do a measurement for one of the danger indicies. Something about depth of the affected tissue – if my sister understood and remembered correctly what was said, this depth is what was too small to measure.

The surgery for Tuesday is basically to widen and deepen last week’s tissue excision. The dermatologist said she thinks they got all of it, but now that they know what they know, they want to do a more thorough removal of any cancerous tissue that might be left.

So far there hasn’t been any discussion of what’s next, if anything, beyond more tissue tests and monitoring.

Where are the best places for info? What are the survival rates for those diagnosed under what might be badly termed “ideal” circumstances-- about as early as possible to do so, and without any apparent spread to secondary locations? Should she be expecting more treatment – some kind of chemotherapy? What kind of questions do we need to be asking of the medical people?

2

I don’t have any particular medical knowledge, but Mr. Legend had a similar experience. He had a weird-looking mole removed, the lab said it was melanoma, and his dermatologist had him come back in to take more tissue. They did samples of tissue at the margins to be sure they got it all. Nineteen years later, the only lasting effects are that I check his moles very frequently and he heads to the doctor at any sign that one of them is changing. He’s never had a recurrence. So tissue tests and monitoring were exactly the treatment he got, and his situation sounds a lot like your sister’s. The most useful information I got from the doctors about follow-up was what the material they gave me about identifying the types of moles to watch and the signs to look for that indicate it’s time to visit the doctor again.

I found a few online resources that cover the topic generally. This one cites a five-year survival rate of 96% for localized malignant melanoma, this one describes the stages and treatment of melanoma, and this is the National Cancer Institute’s melanoma information center.

It’s natural to be really freaked out by the thought of melanoma - once it’s started to spread, it’s one of the nastiest cancers out there. However, when it’s found and removed early, the prognosis is excellent.

3

Sorry to hear about your sister. This must be a difficult time for her and your family. Without knowing a bit more detail, it’s impossible to provide firm answers to the questions you ask, but I’ll give you a best guess.

Melanoma prognosis is based on several factors. One of the most important is the initial depth of the tumor. Tumors invading less than 1 mm are considered very early stage and portend an excellent prognosis. In your sister’s case you indicate that the depth could not be measured. This may mean that her tumor was a melanoma in situ. In this case the tumor cells have not left the very top layer of the skin (epidermis) where they arose. Should this be the case, that’s even better than a <1mm melanoma. The five year survival for either case. assuming no additional poor prognostic factors (e.g. regression or ulceration) is greater than or equal to 95%.

Treatment for melanoma in situ or very thin melanoma typically consists of only local surgical removal with a margin of healthy-appearing tissue and close clinical follow-up to monitor for recurrence, signs of progression, and detection of new melanomas. Additional studies or therapies may be offered on a case-by-case basis. Additionally, I generally recommend skin screenings for first degree relatives

My best wishes to your sister for a speedy recovery.

Choosy Derm MD

4

An excellent source for information about cancer for patients and their families is the American Cancer Society. The following page is the gateway to more information about melanoma [http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?dt=39

5

I had a similar situation to that described by InternetLegend. I am not a doctor but I will give you my understanding in layman’s terms.

I had two cancerous spots removed. One was a melonoma. The melonoma was the only one that the doctors were concerned about even though it was the other nasty looking one that got me to the dermatoligist in the first place.

The problem with melonoma is that it can spread through the body. The cancer from the melonoma can release cells that will attack the lymph glands, etc. The other skin cancers usually stay localized. Surgical removal of skin cancer cells that are not melonoma are almost always routine. While removal of the melonoma cells in their early stage will stop the spread of the cancer, there is an ongoing concern.

I was a aphorisis blood donor before the surgery. After the skin cancer incident I could no longer donate blood because of the remote possibility of lingering cancer cells in the blood.

It’s been years. I get checked every year and there is no reason to believe that I am not cancer free. I don’t even think about it much anymore. I just want you to understand why melonoma is taken seriously by the medical profession.

Ironically, at about the time that I had my melonoma removed an acquaintance of mine lost his wife to cancer that was first diagnosed as melonoma. Don’t let that make you afraid. There is a very, very high chance that all will be well. Really, don’t panic. Just be glad that the situation was recognized and will probably be corrected in a fairly routine manner.

6

She should consider herself lucky.

7

Gilda’s Club. This might be a good place if you have one in your area.

BTW if you have any moles or anything, you should get those checked out by a dermatologist as well.

8

I suggest your sister get a better explanation of what this means.

As a pathologist, I’m not aware of any invasive melanoma whose depth of invasion is too small to measure (melanomas that invade from the superficial layer of skin cells (the epidermis) into the skin’s dermis are the ones that have some potential to metastasize). As another poster mentioned, from your description the tumor could be in situ, that is, remaining in the epidermis and having no opportunity to metastasize.

Melanomas that have invaded less than 1 millimeter are considered “early melanomas” that have a good prognosis, while in situ melanomas essentially do not affect long-term survival. More on early melanomas here. (In case the link to this National Institutes of Health report doesn’t work for you, the key section reads):

"Early Melanoma

For the purpose of this discussion, early melanoma includes melanoma in situ and thin invasive lesions less than 1 millimeter in depth. Data currently available suggest a greater than 99 percent long-term, disease-free survival for patients with melanoma in situ and greater than 90 percent long-term overall survival for patients with lesions less than 1 millimeter"
Best wishes to your sister.

9

As mentioned above, it depends. The slow-spreading versions, if caught in a reasonable time, are apparently fairly easy to deal with. When I sold life insurance, I had a client who had just had a small area frozen off, meaning my new client had just had cancer treatment in the past month, but Hartford didn’t even rate him up. Statistically, it didn’t affect his survival rate in any meaningful way.

10

I have a question that’s been bothering me for years. My mom had a melanoma on her nose which was successfully removed. A couple-three-four years later, she was diagnosed with colon cancer. Is there any correlation between the two?

11

Thank you all for the info. I am slightly less freaked out than before

12

There is no relationship. Also, are you certain it was a melanoma on the nose? Both basal cell and squamous cell carcinoma are much more common on the face than melanoma.

13

Boyo Jim it sounds like your sister’s case is similar to mine. I hope so, because my situation is pretty minor.

I’d been keeping an eye on my moles for a long time, and I noticed one that looked more like a Venn Diagram than I liked. My dermatologist removed it in January 2004, and it was melanoma. Luckily for me it was In Situ melanoma, described to me as “Stage Zero”. (Cancers are often described in Satges, with higher numbers worse. There is no Stage 5. :frowning: ) He took some more tissue around it to make sure it had not spread, and it hadn’t. I’ve had a number of suspicious moles removed since then, and they were all benign (as were any moles he’d removed before), including two I had removed just two weeks ago.

I have is a scar on my left upper arm, just below the shoulder. The scar is about 3 inches lone and a quarter inch wide. I’m sure I could have the scar dealt with cosmetically, but I’m waiting for a good story to go with it. Something about rescuing a damsel from a biker bar …

That was basically it, but now I see the dermatologist every 6 months instead of every year (or so). Before my melanoma incident, he would have told me to keep an eye on the suspicious mole for changes. Now if there are any moles that have changed or that look funny, he’ll remove them for analysis.

The was a Star Trek Original Series episode where the landing party gets exposed to a disease that causes rapid aging. Everyone’s affected except Chekov. He complains to Sulu that he’s being put through one medical test after another: “Just one more test, Chekov! Skin samples, Chekov! Blood samples, Chekov! Soon there will be no Chekov - only samples!”

Soon there will be no Typo Knig - only samples! :wink:

I’ve become a sunscreen freak. I slather the stuff on all summer (even though I hate it), and I always have a light long-sleeve shirt and a Tilley hat.

Also, my dermatologist suggested I take digital photos of my skin where the moles are to keep track of them, and their changes. He wanted me to bring in a disk with the photos so he has a record. That’s fine, I have no problem with that. I even had no problem with Mama Zappa taking digital pictures of me nekkid. I saved the pictures in a special directory so my home PC wouldn’t use them as a screen saver! If one of the kids stumbled on them :eek:, well there isn’t enough brain bleach in the world for them!!

Melanoma’s bad stuff, but if it’s caught early you’ll be OK. I stongly suggest you check yourself regularly for moles and mole changes - you are a first-degree relative to someone who’s had melanoma. Remember ABCDEF:

Asymmettry (circular good - not circular bad)
Blurred Borders
Color Changes
Diameter larger than a pencil eraser
Evolution (changes over time)
Looks Funny - if you think it’s odd, even if you can’t say why.

If you have a mole that mets any of these criteria, let a pro look at it.

There are plenty of on-line resources. I googled a bunch of stuff at the time. Some of it’s scary, but keep in mind what of all that stuff applies to you and your sister. There was also a web site that tried to teach me how to identify cancerous moles. After taking the test I’m glad I’m not a dermatologist!

Even after he removed my melanoma there are a lot of moles my dermatologist does not think are worth removing. Having a mole that meets any of the ABCDEF tests is not necessarily bad, but that’s not for civilians like us to say.

Hang in there and don’t panic. It’s not even close to panic time.

14

Another detail: I’m 47, so I was 45 when my Evil Mole[sup]1[/sup] was removed.

[sup]1[/sup] Band name!

15

Forgive me because I cannot remember where I read this, only that at the time I felt it was a credible source…

I have read that a daily supplement of Vitimin D will increase the chances of surviving cancer - especially melanomas.

I don’t reckon you should take my word for it, but it might be something you can ask the doctor about, or research on your own.

16

An update. They deepened and widened the original excision on Tuesday. She had been led to believe she would wait a couple of hours for an analysis, but they told her they were sending the sample to a lab for a more detailed analysis. They will have results maybe tomorrow or by Monday.

Also, since the mole was on a flexing portion of her ankle, they decided to leave the wound open because they figured stitches will just pull out. They will look at it again next week, and decide if it’s healing well enough, or they may cover it with a skin graft.