Understanding Melanoma and Surgical Treatment:

Melanoma is a type of skin cancer that develops from melanocytes, the cells that produce pigment in the skin. It is considered the most dangerous form of skin cancer due to its ability to spread to other parts of the body, such as lymph nodes, if left untreated. At the Dermatology Institute of Detroit, we are committed to providing comprehensive care for patients diagnosed with melanoma, offering the essential surgical treatment options to ensure the best possible outcomes.

Understanding Melanoma:

Melanoma often appears as an asymmetric, discolored, evolving or growing lesion on the skin. It can develop anywhere on the body, but it is most commonly found on areas exposed to the sun, such as the face, neck, arms, back and legs. Early detection is crucial for successful treatment, so it is essential to get regular skin checks by your board-certified dermatologist.

Diagnosis and Evaluation:

If melanoma is suspected, your board-certified dermatologist will perform a thorough evaluation, which may include a visual examination, dermoscopy, and possibly a biopsy of the suspicious lesion. A biopsy involves removing a small sample of tissue that is sent to a dermatopathologist for examination under a microscope to determine if cancer cells are present. If melanoma is diagnosed, this will be reported to your dermatologist. In some cases, the specific genetic mutations in your melanoma sample may be tested to further determine the aggressiveness of your melanoma.

Treatment Options:

Surgical removal of the cancerous lesion is often the primary treatment. Based on recent studies, most biopsy proven melanomas should be treated within 30 days of the diagnostic biopsy. There are various surgical techniques to remove melanoma, including:

1. **Excisional Surgery:**

This involves removing the entire melanoma along with a margin of healthy skin around it. The size of the excision will depend on the thickness and location of the melanoma. More recent studies have shown that a 1 centimeter margin of normal skin surrounding the melanoma should be excised to ensure complete removal and prevent recurrence.

2. **Slow-Mohs Micrographic Surgery:**

Mohs surgery is a precise technique used to remove melanoma while preserving as much healthy tissue as possible. It is especially beneficial for melanomas located in areas where preserving tissue is critical, such as the face.

We utilize the “slow-Mohs” technique for melanoma where we will remove the tumor and send it to be checked by a dermatopathologist with results available usually the next day. You will be sent home with a secure pressure bandage while the tissue is checked. If there are more cancerous melanoma cells found by the pathologist, you’ll return for further removal. This process repeats until there are no more cancer cells remaining at which point you will return to our clinic to discuss reconstructive surgery options.

3.**Topical Therapy:**

In rare cases where patients are not good surgical candidates, topical therapy with imiquimod may be considered. Based on the available evidence, application of 5% imiquimod cream daily for 3 months has a cure rate of 60-70% for lentigo maligna type melanomas, though this is an off label use of the medication.

Advanced Surgical Care:

Some melanomas are found to be deeper in the skin at the time of biopsy. The depth of the melanoma is known as the Breslow depth, measured by the pathologist in millimeters. Depending on the depth, these lesions may require surgical oncology care for procedures such as a sentinel lymph node biopsy. This procedure checks local lymph nodes to see if the melanoma has spread.. We work closely with an expert team of surgical oncologists who are experts in such procedures and the management of advanced melanoma that may include immunotherapies.

Follow-Up:

After the melanoma is removed, regular follow-up appointments with your board-certified dermatologists will be established to monitor for any signs of recurrence and to provide ongoing skin cancer surveillance. Most melanoma patients are evaluated every 3-4 months for the first few years after their diagnosis. It is also recommended to establish regular check ups with your ophthalmologist, gynecologist, and dentist as melanomas can also arise in the back of the eye, genital mucosa, and the oral cavity.

Patient Education and Support:

At the Dermatology Institute of Detroit, we believe in empowering our patients with knowledge about melanoma prevention, early detection, and all treatment options. We offer comprehensive education on sun protection measures, including the importance of wearing sunscreen, protective clothing, and avoiding tanning beds. Our team is also dedicated to providing compassionate support to patients and their families throughout their melanoma treatment journey. We are constantly reviewing evidence based practices to ensure we are providing the highest quality care.

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