- Reference Number: HEY-262/2019
- Departments: Plastic Surgery
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This leaflet has been produced to give you general information about malignant melanoma. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.
What is a Malignant Melanoma?
Malignant melanoma is a type of skin cancer that begins in the skin’s ‘pigmentation system’, i.e. the skin layer that becomes tanned in the summer. The skin is made up of two layers, the epidermis and the dermis.
Melanomas usually start in moles or in areas of normal-looking skin. Occasionally it can arise in other parts of the body such as the eye, mouth, under the fingernails or internally. It sometimes spreads to other parts of the body through lymph channels or via the blood stream. It may also spread within the skin itself.
Malignant melanoma is one of many types of skin cancer. It develops in cells known as melanocytes. These are cells, which normally lie in the lower part of the top layer of the skin (epidermis) and produce a pigment called melanin. It is this substance which is responsible for the brown colouration of skin. The job of melanocytes is to make a pigment or colouring for the skin. The pigment helps to protect the body from the ultraviolet light of the sun, which can cause burns.
Moles are examples of lots of melanocytes that have grouped together. Malignant melanoma affects those pigment producing cells and often appears as a new or changing mole.
What causes Malignant Melanoma?
There is strong evidence that ultraviolet (UV) rays from the sun can damage the skin and cause malignant melanoma. People whose skin burns easily are most at risk – typically people with fair skin and fair or red hair and blue eyes. Although malignant melanoma is very rare in childhood, children and young adults who are over-exposed to the sun and suffer blistering or burning are at risk of developing the disease later in life.
Malignant melanoma is twice as common in women as men. The most common site for women is the lower limbs (legs) and for men it is the back. Malignant melanoma is commonly seen in the 40 – 50 age groups but the incidence is increasing in the 20 – 40 age groups. As more people take holidays abroad to sunny climates, the incidence of malignant melanoma and other skin cancers is rising. It is also increasing among people who take part in outdoor activities or occupations.
The use of sun beds which give off artificial UV radiation are also thought to be associated with an increase in skin cancer and malignant melanoma.
What are the Symptoms of Malignant Melanoma?
Most melanomas start in normal skin with less than a third developing in existing moles. If it does develop from a mole, you may notice a change, which may include any of the following:-
- Change in size – the mole may become lumpy or spread outwards over the skin.
- Changes in shape – most moles have a smooth, regular outline but a melanoma is more likely to have an irregular shape.
- Change in colour – the mole may become inflamed or develop a reddish edge. It may become darker or appear to have different shades of colour.
- Itching, crusting or bleeding – these are less common signs but should not be ignored.
The majority of freckles, moles or pigmented blemishes are harmless. If any mole changes, ensure you see your doctor as it is important to recognise if a mole is changing into a melanoma as soon as possible.
Malignant melanoma is one of the rarest forms of skin cancer, but it is the most serious. If malignant melanoma is caught and treated early, it can be cured.
How does the Doctor make the diagnosis?
In most cases your family doctor and/or the specialist can see by examining the mole whether or not it is malignant but if there is any doubt, he or she may suggest an excision biopsy. This simply means that the mole will be removed using a local anaesthetic and examined under the microscope to see if the cells are malignant.
Should the cells prove to be malignant, your specialist will plan your treatment by taking into consideration a number of factors, including your age, general health, the type and size of the tumour and whether it has spread.
It is common for people to be offered a wider excision of the original melanoma depending on the thickness of the melanoma removed to reduce the risk of the melanoma coming back (local recurrence). At the same time, you may be offered a procedure to identify and remove the main lymph nodes that drain the patch of skin where your melanoma was. The procedure is called sentinel lymph node biopsy. This procedure is not required for all patients and it will be discussed with you if it is felt necessary.
How will I be followed-up?
Because you have been diagnosed with a malignant melanoma, there is always the chance of recurrence. It will be necessary for you to be seen in a clinic every 3 months. Follow-up visits will gradually reduce and you may need to be seen in clinic for 1 year or up to 5 years.
Surgery remains the most effective treatment and, research is going on all the time into new types of treatment. For some patients it may be appropriate to offer adjuvant treatments. If the melanoma came back in the same area or somewhere else (recurrence), it may be necessary to perform further surgery, or give you systemic treatment or radiotherapy. This would be discussed with you.
Advice to follow
Because you have had one melanoma removed you have an increased risk of potentially getting another new melanoma. It is important to avoid strong sunlight, particularly at the site of the melanoma, to reduce the risk of developing another melanoma. In addition, sunburn could stop your immune system working as well as it should.
Our advice to you
The best advice we can give you is to avoid too much sun exposure.
- Never allow the skin to burn.
- Avoid the use of sun beds, as radiation contributes to the development of skin cancer.
- Avoid staying out in the sun for long periods.
- Avoid the sun between 10am and 3pm.
- Use sun protection such as factor 30SPF sunscreen with 4 or 5 stars UVA protection. Re-apply every 2 hours and more frequently after swimming. Pay attention also to ears, lips and bald patches as they can also burn.
- Use appropriate clothing (e.g. cotton material or natural fibres) to protect your skin where possible. Wear a wide brimmed hat to protect the face and always wear sunglasses in strong sunlight.
- Perform self-examination of your skin and moles for any changes.
What happens afterwards?
We know sun exposure is generally important to health because it allows your body to make vitamin D, which is crucial for bone health. There is now some evidence that vitamin D may also be especially important after the diagnosis of melanoma. This is very new information and we need the results from further studies before we can be sure it is right but as vitamin D is necessary for many other aspects of your health, there is no doubt that vitamin D levels are important.
Keep your vitamin D levels up
- We recommend that you make an appointment with your GP so that he can assess for Vitamin D levels with a blood test to see if you would benefit from Vitamin D supplements.
- Eat foods that are naturally rich in vitamin D (such as oily fish and eggs) or that have been fortified with vitamin D (such as some yoghurts and cereals).
If you have kidney disease, a high calcium level, kidney stones or heart disease, speak to your doctor before taking supplements. If you are at all concerned, please talk to your healthcare professional.
Other sources of information :
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact:
Plastic Surgery Department on Telephone number (01482) 461078
Dermatology Department on Telephone number (01482) 816777
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.