WHAT IS A MELANOMA?
In many countries, early detection of primarily thin melanomas and improved survival rates have been observed, especially in young females. However, in most countries, the incidence of thick melanomas remains constant or continues to increase, especially in the older age group. Melanoma occurs approximately 1.5 times more often in men than women, and prognosis is slightly better for women, considering other prognostic factors. The anatomic distribution of melanoma is sex-dependent, occurring more often on the trunk in males and on the arms and legs in women. Melanoma can occur at any age but is rare before the age of puberty. The median age at the time of diagnosis ranges between 45 and 55 years, with an increase in incidence after the age of 25 until 50 years.
Current considerations in the epidemiology of melanoma showed that melanoma results from an unidentified interaction between mutations in various genes and constitutional and/or inherited factors combined with environmental factors, mainly ultraviolet radiations. Exposure to UV is the most important environmental factor predisposing to melanoma in susceptible populations. It is reported that people incurring severe burns in childhood appear to be at higher risk for the development of melanoma in later age. Iatrogenic exposures, such as immunosuppressive agents and non-steroidal anti-inflammatory drugs, have been studied as additional environmental factors. Well known host risk factors, such as skin type, family history and genetic susceptibility, have been validated as risk factors on large-scale association studies.
Melanoma usually appears as an irregularly pigmented skin lesion with an irregular border and a tendency to grow or to change over time. Melanomas arise mostly de novo (anew), just occasionally within a congenital or acquired naevus (birthmark).
The most important prognostic indicator of survival is the thickness of the melanoma as measured by Breslow’s thickness, this is divided into T1 (0-1.0mm), T2(1.01-2.0mm), T3(2.01-4.0mm) and T4 4.0mm+. Sentinel node biopsy is indicated in many cases and allows us to pin point the specific lymph node(s) draining the specific area of the melanoma. This is based on MSLT-1 trials that allows us establish the extent of the disease. Dr Farhadieh will discuss this with you during your consultation.
THE PROCESS OF GETTING TREATMENT
If you are concerned about a lesion, you should visit your general practitioner who will then perform an examination of the site under a microscope (histopathology) and/or a punch biopsy. General practitioners, who suspect the lesion may be a type of skin cancer, will then write you a referral.
If you have been referred to us by your general practitioner, and the referral has been faxed to us, the team here at Panthea Clinics will contact you as soon as possible to book you in for an initial consultation to see Dr Farhadieh. At your initial consultation, Dr Farhadieh will review the histopathology results and perform a punch biopsy if one has not yet been done. At this consultation, surgical options will also be discussed, along with possible risks and complications.
Melanomas can be life threatening, and treatment therefore usually requires a multidisciplinary team including oncologists, radiation oncologists as well as surgeons. Wide excision represents the standard treatment for primary melanoma and has the primary goal of achieving durable local control of disease, minimising the risk of local recurrence and curing patients with clinically localised melanoma. Wide excision involves removal of a surrounding margin of normal skin, en bloc with subcutaneous tissue down to the muscular fascia, which should be excised only if clearly infiltrated. It is a simple surgical procedure, performed in many cases uder local anaesthesia. When complex reconstructions techniques are indicated, a procedure under general anaesthesia may be required.
WHAT YOU SHOULD KNOW
Every surgery carries complication risks, no matter how small or trivial here at Panthea Clinics in Sydney and Canberra, we discuss all of these with you at your consultation.
To ensure the highest quality outcome, we like to see our patients at regular intervals following the initial postoperative consultation. If at any stage you have questions or concerns about your surgery or healing process, we are more than happy to discuss them with you day or night. It’s our belief that the trust between you and your surgeon is the most important factor in the surgical process. Our practice is based on compassion, honesty transparency and patient welfare. We pride ourselves on making sure that our patients feel supported through each stage of the journey.
Before proceeding make sure that you have read all the information sheets and have your questions answered.
Frequently Asked Questions
You will need to obtain a referral, as this will allow us to have a direct line of communication with your general practitioner.
It depends on the extent of the lesion and reconstruction needed. Often skin cancers can be managed under local anaesthetic or with twilight sedation. In some cases general anaesthetic is indicated.
Surgery without scars is impossible but remains the holy grail of plastic surgery. The art of plastic surgery is making sure that surgical incisions are camouflaged and are blended into the normal skin creases. Time and postoperative scar management often help a great deal in hiding the telltales of surgery.
It depends. Most skin cancer surgery recovery is quick, and most people are able to resume normal activities the next day.