What is melanoma?
Melanoma is one of the most serious and aggressive types of skin cancer. It is the fourth most common of all cancers in New Zealand.
As well as the cancer affecting the area of skin where it formed, melanoma has the ability to spread to lymph nodes and potentially other organs via the bloodstream, if not caught early.
Melanoma first occurs in the cells that create your skin colour. A potential first sign of melanoma is change to an existing mole or freckle, or the appearance of a new one.
Melanoma requires prompt treatment to reduce the risk of spread to other areas of your body.
Steps to take if you have a suspicious spot on your skin
The first step is to make an appointment to see Dr McMillan in his private rooms at Fernbrae House, Dunedin or in Ivercargill to review your new or changed mole or freckle.
McMillan will use a small magnifying device called a dermatoscope. The dermatoscope allows a close-up view of moles and freckles, allowing Dr McMillan to see if melanoma is a possibility.
If melanoma is suspected Dr McMillan will discuss treatment options and you will together decide on the next steps.
What treatment is available for melanoma?
Surgical excision – surgically removing the melanoma from the skin is the first step. If this is done early enough the melanoma may be removed entirely at this stage.
Sentinel node biopsy – if melanoma spreads, the sentinel (or first node) is the first lymph node the cancer would spread to. If the initial surgical excision indicates that the melanoma may have spread then a biopsy of sentinel nodes may be recommended to determine if it has spread to your lymph nodes.
Inguinal and axillary lymph node clearance – when melanoma has been shown to have spread to lymph nodes then removing them, usually from your armpit or groin area is the best course of action to ensure removal of the cancer.
What happens when it is melanoma?
A procedure called a wide local excision will be performed to remove the melanoma from your skin. The purpose is to make a cut that is wide enough to capture the whole melanoma, making sure there are no cancerous cells left behind.
Surgical excision of melanoma can be done under local or general anaesthetic and is usually a day surgery procedure. This can be performed either at Fernbrae House or Mercy Hospital, Dunedin.
Once the melanoma has been surgically cut out, sutures will be used to stitch the skin together and a dressing applied to assist with wound healing. The removed melanoma will be sent for testing.
If the results come back that the whole of the melanoma was removed in the procedure, no more action is needed. Regular skin checks are recommended, and returning to Dr McMillan is recommended if you find any new or changed moles or freckles. Dr McMillan can discuss this with you after your procedure and organise yearly reviews at Fernbrae House.
However, if the results indicate melanoma may have spread, your skin cancer journey is not yet over and Dr McMillan will discuss further surgical treatment with you.
There may some tenderness at the surgical site. Depending on the site and size of the wound you may have some restrictions to your movements for a short period of time.
Sentinel node biopsy
Sentinel node biopsy is a surgical procedure done under general anaesthetic at Mercy Hospital.
The day before your procedure you will have a small amount of radioactive liquid injected into the scar where the melanoma was taken from your skin. During your surgery you will have some blue dye injected in the same place. These two substances will be picked up by the lymph vessels and carried to the lymph nodes, making it easier to find the sentinel node.
During surgery a device that detects radioactivity is used to locate the lymph node where the radioactive liquid has collected. This is where your sentinel node will be found. A small incision is made over the area (usually only about 4cm long) and the node to be removed will be easily identified by the blue dye injected earlier.
Once the node has been removed sutures and a dressing will be put in place to ensure wound healing. The removed node will be sent for testing. The results of the biopsy will determine if further surgery is needed. Mr McMillan will discuss with you the next steps once the results are known.
Sentinel node biopsy is a day surgery procedure. An overnight stay in hospital is not required. You will have a scar from this procedure, which will heal over time.
There may be some restrictions to your movements for a short period of time.
Inguinal and axillary lymph node clearance
Lymph node clearance surgery is done under general anaesthetic at Mercy Hospital.
During the procedure you will have a cut made either in your armpit (axilla) or groin (inguinal) area depending on which lymph nodes the melanoma has spread to.
The lymph nodes will then be carefully removed. This usually takes between 2-3 hours.
Once the lymph nodes have been removed, small drains will be put in place and the wound will be sutured.
There will be a hospital stay for about 2-3 days after axilla lymph node removal and about 5-7 days after inguinal lymph node removal. In general, movement will be essential, but there may be some restrictions due to the surgery.
The drains placed during surgery will remain for about a week after the surgery. You will go home with the drains in place.
It is likely you will need about 2-4 weeks off work.
Risks and complications
As with all surgical procedures there are risks and potential complications with any melanoma treatment.
Dr McMillan will discuss all of these with you during your consultation and answer your questions.
Melanoma treatment cost
There is a cost for melanoma treatment done privately. The exact figure will depend on a range of factors but generally the cost is between $1,100 for simple excision ranging to $18,000 or more for lymph node clearance (including anaesthetic and hospital costs). This will be eligible for health insurance funding/part funding depending on your policy.
If you have a suspicious looking skin change take prompt action to ensure any melanoma is treated early. Get in contact to make an initial consultation with Dr McMillan about melanoma treatment.