Questions on melignant melanoma
Question: I have recently had a mole removed from my skin and the doctor says that this is a malignant melanoma. What does this mean?
Answer: Unlike normal moles, a malignant melanoma has gained the ability to invade into the surrounding tissues.
Question: Why is this dangerous?
Answer: If the mole grows deep enough, it can invade into blood vessels or more commonly lymphatic vessels. Lymphatic vessels are similar to blood vessels and carry fluid from a specific area to a lymph node where the fluid is examined by white cells which act as guards to ensure no bacteria or viruses are trying to gain entry into the body from that area.
If the tumour cells from the malignant melanoma invade into a lymphatic vessel, they can then migrate to the local (sentinel) lymph node) and from there spread onwards to other lymph nodes and eventually enter the blood stream.
The tumour cells circulate around the body looking for a tissue which will support their growth by being rich in nutrients.
Question: If they grow for example in the liver or the lungs why should this matter?
Answer:Once a malignant melanoma starts to grow in the liver or the lungs, it replaces normal liver or lung tissue. If it replaces only a small amount, then it may have no effect on how you feel. However, once the tumour replaces a large volume of lung or liver, then these organs can no longer function properly and you need your lungs and liver to stay alive.
Question: Is there any way I can know if the mole that has been removed has already spread to the surrounding tissues or my lymph nodes?
Answer: Occasionally one can feel swollen lymph nodes that drain the area coming from the skin where the mole was. In the majority of cases, there is nothing to feel. The chances that the mole has spread depend on how far the tumour has invaded into the surrounding tissues. Once a malignant mole has been diagnosed, the skin specialist or surgeon will recommend further removal of the surrounding skin to try and remove any tumour cells that may have escaped when the tumour was first excised.
Question: Does this mean that if the mole has penetrated deeply into the tissues, it will have definitely spread to my lymph nodes?
Answer: No. All tumours are different. Some will have spread to the lymph nodes while others may have invaded the local tissues but not reached the lymphatic vessels.
Question: Is there any way I can find out if the lymph nodes are affected?
Answer: Up to recently, few doctors would recommend any further investigation to look for evidence of spread to the lymph nodes.
This is now slowly changing with the sentinel lymph node draining the area of skin where the malignant mole was, being removed. The hope is that by removing the draining lymph node which may contain tumour cells, you have caught the tumour in time before it has migrated to other lymph nodes and entered the blood circulation.
Question: Unfortunately, I have been told that my tumour has spread to other parts of my body. Is there anything else I can do?
Answer: This is a difficult situation. Your cancer specialist may suggest trying a chemotherapy drug called dacarbazine which slows down tumour growth in approximately 15% of people with melanoma. It is probably worth trying for three cycles to see if it has any effect as compared to many chemotherapy drugs, it has relatively few side effects.
Question: Is there anything else I can do?
Answer: Ask your cancer specialist if there are any trials you can enter that are looking at new treatments. If you have no options, contact us for advice.