Melanoma care

Melanoma is the most serious form of skin cancer. It starts as an existing mole or a new skin growth. Melanocytes are the pigment (color) producing cells in the skin. These cells can become damaged, often by the sun or tanning bed use, and grow abnormally.

Abnormal cells can then turn into cancer cells which can grow uncontrolled. If left untreated, the cancer cells begin to grow deeper into the skin's surface. When this happens, there's a chance it can spread to lymph nodes or other parts of your body.

The most common type of skin cancer is basal cell carcinoma, followed by squamous cell carcinoma and melanoma. Melanoma is the most aggressive, with a higher risk of spreading past the surface of the skin to other parts of the body.

Your cancer care team includes a primary care provider and many highly-trained specialists. A nurse navigator will coordinate your cancer care to ensure you understand each step and receive the best care possible.

See your test results, review appointment notes and securely message your care team in your Allina Health account.

Allina Health Cancer Institute – Saint Paul has a multidisciplinary team that specializes in stage three (III) melanoma. That means you can get imaging and see multiple specialists in one visit. The team includes specialists in surgical and medical oncology, dermatology and imaging. 

For more information about the multidisciplinary melanoma clinic, call 651-241-7174.

Your health care team will diagnose and help manage your melanoma. Your health care team may include your primary care provider, dermatologist, surgeon, oncologist, nurses and other experts.

You'll start with a physical exam, where you'll discuss your health and family history. During this exam, your doctor will look at your skin for signs of melanoma. If you have an abnormal-looking mole, your health care provider will perform a biopsy, which removes the mole or a small sample of tissue for testing under a microscope. If your biopsy shows that you have melanoma, your health care provider will refer you to a surgeon for treatment that's based on the stage of the melanoma.

The stage of cancer is based on TNM Staging System:

• T (Tumor): The T stage is based on how far the tumor has invaded into the deeper tissues, ranging from 1 to 4. The depth of the tumor is determined by examining it under a microscope and using a special tool to measure it. The thicker the growth, the more serious the cancer.
• N (Lymph Nodes): The N stage determines if there are lymph nodes involved with melanoma. This can be determined by physical exam, imaging, or by removing one to three lymph nodes at the time of surgery and looking at them under the microscope to determine if the melanoma has spread to the lymph nodes.
• M (Metastasis): The M stage determines if melanoma has spread to distant parts of your body. Imaging tests, such as ultrasound, MRI, CT scan, or PET scans can look for additional sites of disease and a biopsy may be done to confirm metastatic cancer (cancer that has spread).  Your health care team will help you decide which testing is right for you.

You and your health care team will work together to create a treatment plan that's right for your unique needs. Treatment for melanoma depends on your general health, the stage of your cancer and:

• the depth the melanoma goes into the deeper tissues
• if you have lymph nodes with melanoma in them
• if the melanoma has spread to other parts of your body

Treatment for melanoma may include one or more of the following:

• Surgery: the melanoma and some normal tissue around it are removed (wide local excision) or where the lymph node may also be removed to check for the spread of melanoma (sentinel lymph node biopsy).
• Targeted therapy: that uses medicines designed to target specific features of cancer cells and stop them from growing and spreading. Immunotherapy is the most common type in treating melanoma.
• Imlygic® injections (T-VEC): destroys melanoma cells in or under the skin or in the lymph nodes. T-VEC is injected directly into the melanoma tumors.
• Radiation therapy: uses high-energy radiation (X-rays) to shrink or destroy the cancer cells.
• Clinical trials (cancer treatment studies): aim to improve the prevention, detection and treatment of melanoma. If you're interested in being part of a clinical trial, ask your medical oncologist if there's one that would be right for you.

You'll likely see a primary care provider or dermatologist first if you have a concerning skin lesion. If they suspect melanoma, they will do a biopsy and may refer you to a surgeon. Questions to ask your health care team:

• How treatable is melanoma?
• What stage of melanoma do I have?
• What is the most commonly recommended treatment for my melanoma?
• How will treatment affect my daily life?
• Will treatment affect my fertility?
• Does melanoma spread?
• Can my melanoma be cured?
• What support resources are available to help me?
• Whom should I call if I have questions after I leave the office?

• Stage 0: The melanoma is only found in the epidermis and has not spread. This stage is also called melanoma in situ.
• Stage I: The melanoma has grown into the skin (dermis) but has not spread to the lymph nodes or other parts of your body.
• Stage II: The melanoma has grown deeper into the skin but still has not spread to the lymph nodes or other parts of your body.
• Stage III: The melanoma has spread to nearby lymph nodes but has not spread to other parts of your body.
• Stage IV: The melanoma has spread to distant lymph nodes or other parts of your body such as the liver, lungs or brain.

What causes melanoma?

The main risk factor for getting melanoma is exposure to ultraviolet (UV) radiation from the sun, sunlamps and tanning beds. There are other risk factors for melanoma that you can and can't control.

What are the symptoms of melanoma?

Melanoma can occur anywhere on your skin. The most common sign of melanoma is a change in an existing mole, including changes to the same, color, size or feel.

What can I do to prevent melanoma?

The best way to prevent melanoma is to protect yourself from UV exposure and to do skin self-exams on a regular basis. Learn more about ways you can prevent melanoma with these skin exam and protection tips.