An Investigation:: Malignant Melanoma

Dermatologist speaks on melanoma treatments

If the doctor suspects that a spot on the skin is melanoma, the patient will need to have a biopsy. A biopsy is the only way to make a definite diagnosis. In this procedure, the doctor tries to remove all of the suspicious-looking growth. If the growth is too large to be removed entirely, the doctor removes a sample of the tissue. A biopsy can usually be done in the doctor's office using a local anesthetic. A pathologist then examines the tissue under a microscope to check for cancer cells. Sometimes it is helpful for more than one pathologist to look at the tissue to determine whether melanoma is present.

A person who needs a biopsy may want to ask the doctor some of the following questions:

• Why do I need to have a biopsy?
• How long will it take? Will it hurt?
• Will the entire tumor be removed?
• What side effects can I expect?
• How soon will I know the results?
• If I do have cancer, who will talk with me about treatment? When?

If melanoma is found, the doctor needs to learn the extent, or stage, of the disease before planning treatment. The treatment plan takes into account the location and thickness of the tumor, how deeply the melanoma has invaded the skin, and whether melanoma cells have spread to nearby lymph nodes or other parts of the body. Removal of nearby lymph nodes for examination under a microscope is sometimes necessary. (Such surgery may be considered part of the treatment because removing cancerous lymph nodes may help control the disease.) The doctor also does a careful physical exam and, depending on the thickness of the tumor, may order chest x-rays; blood tests; and scans of the liver, bones, and brain.

Available Cancer Treatment

After diagnosis and staging, the doctor develops a treatment plan to fit each patient's needs. Treatment for melanoma depends on the extent of the disease, the patient's age and general health, as well as other factors.

People with melanoma are often treated by a team of specialists, which may include a dermatologist, surgeon, medical oncologist, and plastic surgeon. The standard treatment for melanoma is surgery; in some cases, doctors may also use chemotherapy, biological therapy, or radiation therapy. The doctors may decide to use one treatment method or a combination of methods.

Some patients take part in a clinical trial, which is a research study using new treatment methods. Such trials are designed to improve cancer treatment. (The Clinical Trials section has more information about clinical trials.)

Getting a Second Opinion

Before starting treatment, the patient may want a second doctor to review the diagnosis and treatment plan. It may take a week or two to arrange for a second opinion. A short delay will not reduce the chance that treatment will be successful. Some insurance companies require a second opinion; many others will cover a second opinion if the patient requests it.

There are a number of ways to find a doctor who can give a second opinion:

• One doctor may refer the patient to another who has special interest and training in treating melanoma.
• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
• Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.
• The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their background. This resource is in most public libraries.

Preparing for Skin Cancer Treatment

Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the doctor. Often, it helps to make a list of questions. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor--to take part in the discussion, to take notes, or just to listen.

These are some questions a patient may want to ask the doctor before treatment begins: