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Melanoma(203) 785-4191

Overview of Melanoma and Melanoma Treatment
Melanoma is a type of cancer that begins in cells of the body called melanocytes that contain pigment and give color to the skin and hair. Melanomas are most commonly found on sun-exposed skin but can develop in unusual places such as under the nails, the eye, in the nasal passages, the mucous membranes of the mouth or rectum, or in the genital areas.

Dermatologists provide the initial care of patients by taking a biopsy or removing an unusual looking mole or skin lesion. The specimen is examined under the microscope by expert skin pathologists, and if melanoma is present, the patient is referred to experienced surgeons for a more extensive excision of the melanoma lesion. At this time, depending on the appearance and depth of the melanoma under the microscope, additional diagnostic studies are ordered to determine if the melanoma cells have spread to other internal organs. Using a special radiographic dye procedure called lymphoscintigraphy, the lymph nodes closest to the melanoma lesion are mapped and then resected by a surgeon. If the lymph nodes contain melanoma cells, the rest of the lymph nodes in the same area are removed by the surgeon.

Many melanomas can be cured by surgery alone. However, even at the time that the initial melanoma is detected on the skin, some patients will already have spread of malignant cells to other parts of the body, even if the malignant cells cannot be immediately seen on studies such as CT scans, other x-rays, or PET scans. Over the course of time, tumors may grow in the lungs, the liver, or other organs. Spread of the melanoma to other parts of the body is called metastatic disease, and if untreated, can lead to death over a period of months to years.

Once the primary (initial) melanoma has been excised by a surgeon, patients are referred to a medical oncologist. Depending on risk level, some patients will be offered standard or investigational treatments to reduce their risk of developing metastatic disease in the future. Patients are followed by the oncologist intermittently (every 3-6 months) for evidence of disease recurrence. In addition, continued screening by dermatologists every 3-6 months is recommended in order to detect and remove any new primary melanomas that may occur elsewhere on the skin.

If metastatic disease is detected by physical exam or by diagnostic studies such as CT scans or PET scans, treatment can be offered. In most cases, the treatment consists of medications taken by mouth or administered into a vein. Systemic treatment (meaning that the treatment distributes throughout the body) is important because most patients will continue to develop new tumors in addition to continued growth of the tumors that are observed on physical exam or diagnostic studies. If treatment is unsuccessful, the spread of the melanoma tumors can be fatal. At this time, standard treatments for melanoma are effective in only a small percentage of patients. Cancer Centers such as Yale offer investigational treatments for metastatic melanoma, and maintain laboratory research programs to discover new ways to treat the disease.