Melanoma

Melanoma is the 7th most common cancer in Canada. It is a skin cancer that has the potential to spread to lymph nodes and other organs in the body. 50% of melanomas are thin (less than 1mm) and when treated with wide local excision alone, have a survival of over 95-98%.

The other 50% are high risk thin melanomas (0.75mm-1mm with any high risk feature such as young age <45 years old, ≥ 1mitosis or ulceration), intermediate thick melanomas (1-4mm) or thick (more than 4mm) melanomas need further investigation with a staging procedure known as a sentinel node biopsy to evaluate if melanoma has spread to the lymph nodes.

Not all melanomas are the same and therefore a detailed consultation with your physician/surgeon is very important once the diagnosis has been made.

Merkel Cell Carcinoma

Merkel Cell Carcinoma is very rare type of skin cancer that can spread to lymph nodes and other organs.  It often looks like a rapidly growing pinkish/purple nodule. It is important that this rare cancer be treated in a specialized tertiary care cancer center as The Ottawa Hospital.

Squamous Cell Carcinoma

Squamous Cell Carcinoma is often very localized and local surgical excision is often the only treatment required.  In rare cases, however, these skin cancers can be more locally advanced and spread to lymph nodes requiring more extensive surgeries.

Dr. Carolyn Nessim actively treats melanoma and other skin cancer patients through the Ottawa Hospital Regional Cancer Center.

She is currently the regional lead of the Melanoma Communities of Practice for the Ottawa Regional Cancer Program.  She also sits on Cancer Care Ontario’s working group for creating guidelines in the treatment of melanoma. Melanoma is cared for by a multidisciplinary team including a Dermatologist, Surgical Oncologist, Plastic Surgeon, Medical Oncologist, Radiation Oncologist, Pathologist and Nuclear Medicine Physician.  The Ottawa Hospital has a dedicated melanoma team to care for melanoma and other skin cancer patients.

Dr. Nessim has been on CTV discussing the typical features of melanoma and what to look out for:

Mole or Melanoma?

Frequently asked questions

Why do I need a wider excision if my melanoma was already removed at the time of the biopsy?

Depending on the thickness of your melanoma, you will require an additional 1-2cm wider excision around the original site of your melanoma and this skin must be removed all the way down to your underlying muscle.  You may require a skin graft or flap to fill in the gap that was created by the excision.  This may require the expertise of a plastic surgeon.  This wider excision is to prevent the melanoma from coming back in this location.

What is the likelihood of getting another melanoma?

Your risk of getting another melanoma ranges between 5-7% in your lifetime.  This is why you will require regular skin checks by a dermatologist after your surgery.

What is a sentinel node?

The sentinel nodes are the first few nodes that drain a specific area of skin.  The Nuclear medicine physician injects a special dye around your melanoma.  This dye will travel through your lymphatics and stop in the first few nodes that drain that specific area of skin.  These are the sentinel nodes. If cancer will spread, it will go to these nodes first. Most people have 1-4 sentinel nodes, it all depends on your personal anatomy.  The entire node is removed and then analyzed by a Pathologist under a microscope to see if the melanoma has spread.

What if my sentinel node is positive?

If your node is positive, you may require more surgery or other medical treatments by a medical oncologist. You will require continued surveillance with physical examination and imaging tests as well as skin checks from your dermatologist and surgeon/medical oncologist at a minimum of 5 years after your surgery.

What if my sentinel node is negative?

This is a good prognostic sign and puts your melanoma at a lower risk.  You will require continued surveillance with physical examination and skin checks from your dermatologist and surgeon at a minimum of 5 years after your surgery.

What if I already have large nodes that I can feel in my neck, armpit or groin?

These nodes will require a biopsy to confirm if this is melanoma.  If it is melanoma, then you will require removal of all of the nodes in this area.  The main risk of nodal removal is lymphedema, or swelling of the neck, arm or leg respectively.  This may be permanent but can be actively treated and can significantly improve or even resolve with appropriate physiotherapy and lymphatic drainage massage.  If you have lymphedema, request a Physiotherapist who specializes in lymphedema.

Will I need Chemotherapy?

You will not need chemotherapy.  Chemotherapy is mostly ineffective in melanoma. It is only used in very rare occasions.

Will I need Immunotherapy?

This is a new and very effective treatment for melanoma.  This type of therapy boosts your own immune cells to fight off the cancer.  You will only require this if your melanoma has spread to other organs in your body. This will be discussed with your medical oncologist.  You may require immunotherapy if your node is positive, however this is currently mainly under study in clinical trials only.

Will I need Radiation Therapy?

Only patients with large nodal disease or multiple positive nodes may require additional radiation therapy after surgery. This will be discussed with your radiation oncologist.

What is BRAF?

BRAF is a genetic mutation found in 50% of melanomas.  If you have melanoma that has spread to your organs, this genetic test will be performed.  If you are BRAF positive, you may require a special medication that targets and blocks this gene to help fight off the melanoma.