Melanoma

What is melanoma?

Malignant melanoma is a form of skin cancer which can start in a pre-existing mole or normal looking skin.

What causes melanoma?

Although the cause is not fully understood, there is strong evidence to suggest that Ultraviolet (UV) rays from the sun, or using sun beds, can do damage to the skin.

What are the symptoms?

The first symptoms of melanoma often present in the form a new mole or a changing mole which is irregular in outline, shape or colour.

How is skin cancer diagnosed?

Your specialist will assess your moles in clinic. They may look at your mole/lesion with a handheld instrument called a dermatoscope. If the specialist thinks your mole is suspicious, they normally advise you to have the whole mole removed.

It is recommended that all suspected melanomas initially are diagnosed with surgery, which we call a biopsy.

Treatment

This can either be an excision biopsy or a wide local excision.

Excision biopsy

This involves removing the mole, usually under a local anaesthetic. The biopsy is sent to the Histopathology department, who are able to confirm the diagnosis. Of note, it may take two to three weeks for the biopsy results to be ready. One of the things that will be looked at by the histopathologists under the microscope is how deep or how thick the biopsy is. Thin melanomas are less likely to spread elsewhere in the body.

Wide local excision

If a melanoma is diagnosed as a result of the excision biopsy, the consultant or doctor will recommend a wide local excision (WLE). This involves another operation to remove an extra margin of skin from around the original melanoma site, which is again examined under a microscope. This is to reduce the risk of any melanoma cells being left behind in the surrounding skin.

If possible, the wound will be stitched closed, although sometimes it is necessary to repair the area with a skin graft or other types of plastic surgery. You may require time to get back to your usual routine depending on the type of surgery you have had.

Further treatment

There is a small chance that your melanoma may spread or come back and this may be removed by further surgery.

Research and clinical trials are ongoing to find the best and new treatments. For up-to-date information, please ask your Skin Cancer Clinical Nurse Specialist.

Follow-up

Once surgery is complete, you will have a check-up at the hospital to review the scar and surgical site, and at this point you will formally be given your results. A follow-up plan will also be discussed. If you started your treatment at another hospital, we will discuss getting referred back to them.

Self-examination

You will be shown how to examine yourself to detect any recurrence at the site of removal or in the surrounding skin. This is probably one of the most important things you can do to help yourself. The chance of the melanoma returning remains small for the majority of people.

What to look for:

  • Check for any new or existing moles that change colour, bleed or itch. Most changes are harmless but they may indicate the start of a skin cancer. If you are in doubt, contact your Skin Cancer Clinical Nurse Specialist, or if you have been discharged from our service, please contact your GP.
  • Any dark spots that develop either at or near the site of the removal of the melanoma should be reported to your Skin Cancer Clinical Nurse Specialist.

If any melanoma cells have broken away from the tumour before it was removed, there is a chance that they may spread to your lymph nodes. Lymph nodes are present throughout the body; their purpose is to fight off infections. If the cancer cells spread from the melanoma, they can lodge in the nodes. This may produce lumps, either painful or painless, in the neck, armpits or groins, depending on the site of the initial melanoma.

Even more rarely, in a very small number of people, the melanoma can spread beyond the local lymph nodes to distant nodes, distant skin or other organs, such as the lung, brain or liver.

Any unusual symptoms that persist should be reported. If you would like more information on this please discuss with your
Skin Cancer Clinical Nurse Specialist. If discharged, please go directly to your GP.

How do I examine myself?

Although initially you will be examined at check-up, it is important that once a month you perform your own examination at home.

Take time to look at and feel the scar and the surrounding area. One of the easiest ways to do this is to feel with the flat of your hand against the skin. Many people find this works well whilst having a bath or a shower. This same technique can be used to check the skin between the scar and the lymph nodes and the nodes themselves.

  • For melanomas in the head or neck area you need to examine the nodes in the side of the neck, under the chin, above the collarbones, behind the ears and at the back of the neck.
  • For melanomas on the arm spread may occur in the armpit on the affected side, above the collarbones and in the lower neck.
  • For melanomas on the leg, the nodes behind the knees and in the groin need to be checked. A useful tip is to compare one side of your body with the other.
  • For melanomas on the front or back of your body, please check your groins, armpits and lower neck.

What to do if you are worried?

If you have been discharged, please see your GP. If you are under regular follow-up, please feel free to telephone your Skin Cancer Clinical Nurse Specialist. We would much rather talk it over with you on the telephone or see you and hopefully reassure you rather than have you worry and risk delaying treatment. Our telephone numbers are on the back of this leaflet.

Future protection

  • Take care whilst in the sun
  • Never allow your skin to burn
  • Wear a hat with a large brim
  • Avoid strong sunshine between 11am and 3pm if possible
  • Do not use sun beds
  • Use high factor sunscreens (SPF 30+)
  • Sit in the shade

Pass the message on to your friends and family about the importance of protecting themselves and checking alterations in moles and their skin. Remember that sunscreens should be used as well as the above recommendations.

Insurance

If you already have life insurance, you may need to inform them of your diagnosis.

If you have critical illness insurance you may be able to make a claim.

Travel insurance

Getting travel insurance when you have had cancer can be difficult. From the company’s point of view, you are a higher risk. As they see it, having been ill, you are more likely to need medical treatment while you are abroad. Or they may think that illness could cause you to cancel your trip at the last minute. But finding travel insurance is getting easier.

Fortunately, many insurance companies are now looking at cases individually rather than refusing everyone with a history of cancer.

References and further Information

NGS Macmillan Wellbeing Centre
Southmead Hospital, Bristol BS10 5NB
Southmead Hospital has a drop-in centre offering a variety of activities/services. For more information telephone 0117 414 7051 or ask your Skin Cancer CNS.

Skin Cancer Research Fund (SCaRF)
Based at Southmead Hospital
Telephone: 0117 414 8755
www.skin-cancer-research-fund.org.uk

Macmillan Cancer Support
Europe’s leading cancer information charity with over 4,500 pages of up-to-date cancer information, practical advice and support for cancer patients, their families and carers.
Telephone: 0808 800 1234
http://www.macmillan.org.uk

CancerHelp
CancerHelp UK is a free information service about cancer and cancer care for people with cancer and their families. Cancerhelp believes that information about cancer should be freely available to all and written in a way that people can easily understand.
www.cancerhelp.org.uk

NHS Constitution: Information on your rights and responsibilities
www.nhs.uk/aboutnhs/constitution

How to contact us:

Specialist Nurse Team:
Lynda Knowles
Joanne Watson
Claire Lanfear
Samantha Wells

NGS Macmillan Wellbeing Centre
Southmead Hospital
Westbury-on-trym
Bristol
BS10 5NB
0117 414 7415
SkinCancerCNS@nbt.nhs.uk

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published March 2021. Review due March 2023. NBT002428

Melanoma