Malignant Melanoma

Malignant melanoma is a type of skin cancer which begins in a cells called as melanocytes (these cells gives pigment to the skin).
It is more commonly seen in the white population and is related to the skin damage caused by ultraviolet rays of sun.

Warning Signs

1. Change in size, shape, colour, bleeding or ulceration of any pre-existing mole
2. Any new spots/moles – brown, black or red
3. New pigmentation at the base of the nails

Risk Factors

Malignant melanoma is more common in white population. Certain factors are associated with an increased risk of developing a melanoma

1. Previous sun exposure (UV light)
2. Family history of melanoma
3. Family history of multiple nevus syndrome

Progression

Malignant melanomas can spread very fast. It can spread to the draining lymph nodes, visceral organs like lungs, liver, bone etc.

Diagnosis

Early melanomas can be differentiated from the benign nevus by the popular mnemonic ABCDE –

1. Asymmetrical lesion
2. Border is usually irregular
3. Colour is variable
4. Diameter is >6mm
5. Enlarging lesion

If there is a strong suspicion of a melanoma, a biopsy is performed which can be an excisional biopsy or an incisional biopsy.
Once diagnosis of a melanoma is confirmed, evaluation of draining lymph nodes by sentinel lymph node biopsy is required for lesions >1mm deep. Cross sectional imaging will also be required in many cases.

Treatment in a Nutshell:

Wide local excision of the primary tumour is curable in early stage melanomas.

Biopsy of sentinel lymph nodes is a widely used procedure for skin melanoma. It is commonly performed for lesions >1mm thick. If a lymph node comes positive for disease, a radical lymph node dissection will often be required.

For patients with metastatic disease, medical management and/or radiation therapy will also be required. Medical treatment can include targeted therapy (BRAF inhibitors, KIT inhibitors), immunotherapy (Interferon, anti CTLA 4, Interleukin 2) and combination chemotherapy.

Outcome:

Outcome depends upon factors like type of melanoma and stage of disease.

For patients with disease 1mm or less in thickness, 5 yr survival is more than 90%. For patients with localized disease > 1mm thickness, 5 yr survival is between 50- 90%. For patients with distant metastasis, 5 yr survival is less than 10%.

Milestone

At Best Cancer Hospital – RGCI&RC we offer standard of care treatment for patients with melanoma with molecular testing (BRAF analysis) and standard surgical and medical care.

Our Team

• Consultant Musculoskeletal Oncologist – Dr Manish Pruthi
• Consultant Radiation Oncologist – Dr Swarupa Mitra
• Consultant Medical Oncologist – Dr Doval / Dr Ullas Batra
• Consultant Pediatric Oncologist – Dr Gauri Kapoor / Dr Sandeep Jain
• Consultant Plastic and Reconstructive Surgery – Dr Rajan and more team of doctors