Cancer Research UK : Skin Cancer symptoms and treatment

Skin Cancer symptoms and treatment

This page presents information on the symptoms, and treatment of malignant melanoma.

Malignant melanoma symptoms

A change in the colour, size or shape of an existing mole is the most common symptom of melanoma. To determine which pigmented lesions require further investigation, a 7-point checklist may be used (Table 6.1).

The presence of any major feature is an indication for referral to a specialist centre and the presence of minor features increases suspicion.1

Table 6.1: Seven point checklist for pigmented lesions

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Malignant melanoma treatment

Guidelines on the treatment of malignant melanoma have been published in Scotland and by the British Association of Dermatologists and the Melanoma Study Group.1,2 Guidance on the organisation of services for skin cancer patients by the NHS in England and Wales is expected in 2006.3

Suspected lesions should be removed with at least a 2mm margin of normal skin (see Table 6.2) and a cuff of subdermal fat to enable an accurate histopathological report including a measure of Breslow thickness.4

Staging is based on the TNM classification with revisions from the American Joint Committee on Cancer.5 Stage I and II patients have no nodal involvement and varying thicknesses of tumour with or without ulceration. Stage III patients have evidence of lymph node involvement while stage IV patients have metastatic disease classified accordingly to the site of spread.

Table 6.2: Tumour thickness, excision margins, survival and follow-up

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Patients with early stage disease (stage 0, I and IIA) when the tumours are thin and have no nodal spread can be treated with surgery alone: they have an excellent prognosis with five-year survival rates in excess of 95%.

As tumour depth increases, so excision margins widen and survival is worse as risk of developing nodal metastases directly relates to tumour thickness – see Table 6.2 above.6 Sentinel node biopsy is increasingly used to determine nodal spread with the advantage of limiting radical node dissection to those patients who have evidence of cancer in the sentinel node but its role remains as yet unproven.

Patients with stage IIB and above disease are at risk of recurrent disease and as there is currently no standard adjuvant systemic therapy for these patients, they should be offered entry into clinical trials wherever possible. A number of adjuvant therapies are under investigation to prevent local or systemic recurrence including immunotherapies such as interferon and vaccines and chemotherapy.

Treatment for patients with metastatic disease may include further surgery to remove metastatic disease, single agent chemotherapy with dacarbazine and palliative radiotherapy. Clinical trials are also investigating new combinations of chemotherapy and immunotherapy for stage IV patients.

Early diagnosis is critical if survival rates are to improve further. Patients at risk of melanoma should be referred to specialist centres as rapidly as possible. Studies generally show that delays are predominantly patient- rather than physician-related with longer delays reported for older patients and men.1 This may be one reason why older patients have lower survival than younger patients and men have worse survival than women (see Survival section).

Improving the low public awareness of the risk factors and symptoms of melanoma is therefore crucial. Good patient information is also important as many patients are at risk of disease recurrence and will need to attend for follow-up for several years.

As well as prevention, a key message is for the earlier diagnosis of skin cancer when treatment is much more effective.

This is particularly important for men who are less knowledgeable than women about skin cancer prevention messages and are less likely to do something to protect themselves.7 Consequently men are usually diagnosed at a later stage than women, have significantly lower survival rates and their incidence is increasing at a faster rate than for women while their mortality rates have yet to level off.

Trials are ongoing to determine more effective treatments for both early and late stage melanoma as well as looking at the best type of psychological support and follow-up for patients.8 Advances in understanding the molecular biology of melanoma will help develop new treatments, monitor the effects of treatments and tailor therapies to individual patients.

References for skin cancer symptoms and treatment

Scottish Intercollegiate Guidelines Network,Cutaneous Melanoma. A national clinical guideline. July 2003
British Association of Dermatologists, UK Guidelines for the Management of Cutaneous Melanoma. 2002
. National Institute for Health and Clinical Excellence (NICE)
Breslow, A., Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg, 1970. 172(5): p. 902-8.
Balch, C.M., et al., Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol, 2001. 19(16): p. 3635-48.
Newton-Bishop, J., et al., UK guidelines for the management of cutaneous melanoma. 2002, Melanoma Study Group and British Association of Dermatologists.
Cancer Research UK, SunSmart Sun Protection Survey. 2003
Cancer Research UK CancerHelp. Clinical trials database.

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Skin Cancer symptoms and treatment

Malignant melanoma symptoms

Malignant melanoma treatment

References for skin cancer symptoms and treatment

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