Melanoma Treatment

Melanoma treatment has largely been surgical because in the past chemotherapy has not been effective.  The primary treatment requires local surgical excision of the tumor with a margin of normal tissue.  This margin varies somewhat with the thickness of the primary tumor.  The primary tumor should be excised whenever possible.  In cases of large tumors, an incisional biopsy can be obtained for planning further treatment.  In determining further treatment, two things need to be determined from the biopsy, the Clark Level and the Breslow thickness.  These two factors are used with anatomic site of the tumor to determine the next step, sentinel node biopsy.

Sentinel lymph node biopsy is a process where the first lymph node to which a tumor might spread is determined and removed for study. In some cases there maybe more than one that is identified and therefore both are removed.  If the tumor has not spread to this lymph node it is unlikely to have spread to other lymph nodes, a crucial bit of information in determining further treatment.  If the sentinel lymph node has tumor in it, a regional lymph node dissection may be done.  This is a procedure where a large collection of lymph node are removed.  Lymph node dissection may not affect survival in very thin or very thick tumors but may be helpful in intermediate tumors.

Melanoma is largely treated surgically.  Radiation therapy has not been helpful for primary tumors but may have some benefits in palliation of metastatic disease.  Chemotherapy has also not been helpful for primary melanoma, again used largely in a palliative role.  The recent advances in immunomodulators has shown some promise.  Interferon therapy has shown some benefit in Stage III melanoma, and may have its indication extends by further studies. The last frontier in treatment is immunotherapy or a melanoma vaccine.  Currently the work on this is ongoing but early result do show some benefits in some cases.  As in all cases, the details of your care should be discussed with your physician.

Melanoma, risks and signs

Many people come in to the office because they have a brown spot that they are concerned about.  Although, many of these brown spots, or pigmented lesions as we call them, are benign, some can be pre-cancerous or worse,  a melanoma.  Today we are going to talk about the risk factors and signs of melanoma.  Melanoma is a skin cancer that is definitely on the rise in the United States.  Although it accounts for a small percentage of all skin cancers, basal cell carcinoma and squamous cell carcinoma are much more common, melanoma accounts for most of the death due to skin cancer.

Melanoma can occur in any portion of the body.  Recent studies have shown that melanoma of the trunk and extremities is rising faster than melanoma of the head and neck regions.  The incidence of melanoma is 10 times higher in whites than blacks living in the same geographical region.  So what are the risk factors for melanoma?  The National Cancer Institute has listed the following as confirmed risk factors:   

                             more than 50 moles on a person’s body

                             having an atypical-dysplastic nevus

                             fair skin and light color hair

                             family history of melanoma

                             males greater than females

                             age greater than 50 years

                             having xeroderma pigmentosum

                             personal history of melanoma

                            UV exposure and sunburn

What are the signs you should look for in a pigmented lesion to cause concern?  Quite simply we say ABCD. A is for asymmetry, if you can draw a line through the spot and both haves look alike it is less worrisome. B is for border; if the border is smooth again a good sign.  If the edge is uneven or irregular, that is a cause for concern.  C is for color, multiple colors in a spot are bad. And lastly, D is for diameter.  A diameter less than 5 mm is good.  A simple way to determine that is, if the spot can be covered by the eraser of a pencil it is ok.  None of these are absolute but the combination of two or three certainly requires attention.  As always if you have a question about a spot, you should show it to your doctor.  Next time the treatment options of melanoma.

With winter upon us, many people ask if sunscreen use is necessary in the winter.  The simple answer is yes.  Now we will consider the reason why sun screen should be used.  Although the sun may not seem as hot during the winter months, the sun still is emitting ultraviolet radiation which is a major cause of skin damage, skin wrinkles, and certain types of skin cancer and premature aging of the skin.  The sun emits three types of ultraviolet radiation, UVA, UVB and UVC.  UVC is blocked by the ozone layer and does not reach the earth’s surface.  UVB has long been associated with sun damage and is the major cause of sunburns. UVA has recently been found to cause more damage to the skin than UVB for it penetrates to a deeper level of the skin and damages that layer. Unlike UVB, UVA is more consistent, in that there is no daily or seasonal variation in the amount of UVA that reaches the earth’s surface.

  Now that we understand a little about the sun’s damaging effect, what can we do to prevent the damage?  Sun block, at least SPF 15.  SPF stands for sun protection factor.  It is a measurement developed in the laboratory which measures the amount of light needed to induce redness in sun block protected skin divided but the amount of light to induce redness in unprotected skin.  A simple way to think about this is, if your skin gets red after 10 minutes of exposure to the sun, with SPF 15, it would take 150 minutes to develop the same amount of redness.  It is important to remember that SPF does not protect against UVA.

So why is it important to use sun block in the winter?  Simply because we should use sun block every time we are exposing ourselves to the sun.  The UV radiation does not stop just because it is winter.  The snow causes the reflection of UV radiation which can increase our exposure on bright sunny winter days.  Skiers are more susceptible because the high altitude allows more harmful radiation to hit our skin. Since we do not feel the typical burn of sunburn like in the summer, we tend to stay out for longer periods of time increasing our exposure. Although it always enjoyable to be outdoors on a lovely winter day, as you are dressing to enjoy the day, remember the sun block, you will thank me later.

Do facial creams really work?

Thinking about buying some high-end facial creams as holiday gifts? They seem to be a very popular; however, a study out from the Mayo clinic says that they may NOT be effective based their active ingredients and length of use. 
You may want to consider getting a gift certificate for a micro laser peel or other skin resurfacing procedure instead!