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2014 N.E. Oncology Sympsoium Cutaneous Melanoma Multidisciplinary Perspective Lecture

Melanoma is a cancer of the skin that is highly curable when detected early, but can be lethal when advanced and spreads throughout the body. More common types of skin cancer include basal cell carcinoma and squamous cell carcinoma. These types of skin cancers are not related to melanoma and are far less threatening. Melanoma arises from melanocytes, which are the cells in the skin that are responsible for pigment production. The pigment from the melanocytes accounts for both natural skin color and darkening of the skin with tanning. The team of melanoma experts at the Roger Williams Cancer Center includes surgical oncologists, dermatologists, medical oncologists, plastic surgeons, and pathologists. Melanoma can occur in any individual and arise from any site in the body, including the skin, eyes, and anus. However, those with fair skin, light eyes, a history of heavy sun exposure, and a family history are at highest risk.

Prevention and Treatment

Prevention of melanoma is the most effective treatment. Limitation of sun exposure by wearing protective clothing, sunscreen, and avoiding tanning bed use are the cornerstones of melanoma risk reduction. Annual skin exams by a dermatologist can lead to early detection of melanoma, at which point, the disease is highly curable.

When melanoma is diagnosed, the first step is to determine if the tumor has spread to other areas of the body, including the lymph nodes, lung, and liver. Your cancer care team at the Roger Williams Medical Center will determine the extent of disease by physical examination, x-rays, CT scans, and PET scans as needed. The risk of spread to lymph nodes and other sites can be predicted based upon the thickness of the melanoma, among other features. Each individual's tumor is different, and the need for advanced tests such as CT scans and PET scans is determined on a case-by-case basis.

For patients with tumors that are confined to the skin and/or nearby lymph nodes, surgery is the mainstay of treatment. Your surgical oncologist will remove the tumor and some surrounding normal skin to ensure complete eradication. In some cases, depending on the aggressiveness of the tumor, your surgical oncologist will sample the nearby lymph nodes to determine if spread has occurred. Additional therapy such as interferon, immunotherapy, chemotherapy, or radiation therapy may be recommended, depending on the extent of tumor spread. For patients with advanced disease, we encourage consideration of immunotherapy clinical trials, either at Roger Williams or another center specializing in cancer care.