LibNOTSr is of very Irish complexion and decent. Unfortunately, I am very susceptible to skin cancer and have had several minor surgeries over the last several years. Basil cell carcinoma has been removed from my neck and face surgically at least three times. I currently visit my Dermatologist every three months for a check-up. With careful examination I feel pretty good about my chances of keeping future basil cell cancers under control. But………..I noticed a dark brown “freckle” on the inside of my thigh about two years ago. My friend Dr. B suggested I keep an eye on it: changes in size, itching, bleeding, scaling and so on. Well dear friends…it did not change, but I decided to exaggerate to the good doctor that it had. When I told him it (the freckle) changed - without hesitation he prepared me for slicing off the freckle for biopsy. A week later he called to say that the biopsy came back positive for Melanoma. Ouch! Scary stuff! Long story short….out patient surgery and everything is fine.
Now, as I understand it, melanoma is not typical of many skin cancers and it is certainly different from basil cell which is more likely caused by exposure to the sun. Melanoma in my case was in a place on my body where, believe me, the sun did not shine.
So libNOT.com readers, here is an important story about detecting the very deadly melanoma cancer in an article from one of the best newsletters available: Carole Jackson’s, Bottom Line’s Daily Health News
New Test for Melanoma May Save Lives
According to the National Cancer Institute, more than one million new cases of skin cancer (including basal cell and squamous cell) will be diagnosed in the US this year. That’s not what I consider a sunny statistic. Even darker is that one type of skin cancer, melanoma, is by far the most deadly. It is estimated that around 60,000 new cases of melanoma will be diagnosed this year, and more than 8,000 people will die from the disease.
But here’s some blue sky. A report published last fall in The New England Journal of Medicine suggests that sentinel-node biopsy can improve some patients’ chances of survival.
CURRENT MELANOMA CARE
Melanoma is graded in stages (0 to IV), where stage 0 generally involves only the top-most layer of skin… in stages I and II, the tumors are getting progressively thicker… in stage III, the cancer has spread beyond the tumor to one or more lymph nodes… and stage IV involves distant metastases, where the cancer has spread to other parts of the body.
Except in large, research-oriented cancer centers, the treatment for the early stages of melanoma usually consists of removing the tumor (cutting it out of the skin), followed by periodic check-ups to see if any of the lymph nodes are swollen, which is a signal that the cancer may have started to spread. If that happens, the patient undergoes a lymphadenectomy — the surgical removal of the lymph nodes in the area (such as the armpit, groin or neck), which are then studied by a pathologist. If the cancer does not show signs of spreading, the patient simply remains under a doctor’s supervision. But if the cancer is thought to have spread, additional treatments — radiation, chemotherapy, etc. — are often required.
The problem with this system? In some cases, the melanoma has already spread to the lymph nodes, even though the lymph nodes aren’t swollen enough to be noticeable. That makes the “watch-and-wait” approach risky — and makes sentinel node biopsy an attractive option. How attractive? In those who turned out to have nodal metastases, survival rate after delayed lymphadenectomy hovered just over 50%, while in those that had sentinel-node biopsy followed by immediate lymphadenectomy, the survival rate soared to 72%.
THE SENTINEL-NODE BIOPSY
With sentinel-node biopsy, a “tracer substance” (a radioactive substance and/or dye) is injected at the melanoma site prior to the tumor’s removal. The physician then monitors which lymph node the material moves into first — this is the sentinel node. During the surgery to remove the cancer, this node is also taken out so that it can be checked for cancer cells. If none are found, it’s less likely the cancer has spread. If cancer cells are found, however, a more radical lymphadenectomy would be in order.
According to Andrew Spillane, MD, a surgical oncologist (and sentinel-node biopsy expert) at the Royal Prince Alfred and Mater Hospitals in Sydney, Australia, the major finding of the study is that there was a very significant difference in survival between the two pre-selected patient groups. (He also points out that the fact that the comparison of the two groups was not randomized has raised some criticisms of the study, but a randomized trial of the groups would have been impossible to achieve.) Plus, sentinel-node biopsy is performed when fewer lymph nodes are involved and usually less bulky than they would be during a delayed lymphadenectomy. This can mean a technically easier operation with potentially fewer complications. “These potential benefits have to be compared to the usually minimal risks associated with the sentinel-node biopsy procedure for all patients with moderate and high-risk melanomas,” said Dr. Spillane.
While only 16% of the sentinel-node-biopsy patients had cancers that had spread, the higher survival rate (that astonishing 72%) due to earlier detection, combined with the decreased risk of complications, are enough to make sentinel-node biopsy a diagnostic treatment worth asking about.
WHAT YOU NEED TO KNOW
According to Dr. Spillane, if you or someone you care about has recently been diagnosed with melanoma and the cancer is greater than 1 mm thick, you may want to investigate a sentinel-node biopsy. That means not only asking your doctor about the procedure, but also asking how experienced the entire team — surgeon, nuclear medicine specialist and pathologist — is with the procedure. Melanoma is serious business, so don’t hold back — if your physician seems hesitant, it might be time to find someone else to work with. After all, early diagnosis and treatment are key to beating the disease — and efficient, effective prognostic tests like sentinel-node biopsy to help determine treatment can up your odds.
Of course, I cannot talk about melanoma without talking about ways to reduce your risk of the disease in the first place. It’s simple:
1. Avoid excessive sun exposure and sunburn. Use a sunblock with a minimum SPF of 15, every day if you’ll be outside more than just a few minutes.
2. Pay attention to your skin. Check yourself regularly for any new moles or lesions, especially those that ooze, bleed or become ulcerated. Get regular skin-cancer screenings.
3. If a mole is changing in size, shape or color — for example, if a mole seems larger or has jagged edges — have it examined and biopsied.
For more information on skin cancer prevention and treatment, visit the American Cancer Society Web site at www.cancer.org. And be safe out there!
Andrew Spillane, MD, a surgical oncologist and sentinel-node biopsy expert at the Royal Prince Alfred and Mater Hospitals in Sydney, Australia.