Skin Cancer Repair – Melanoma

The Most Dangerous Skin Cancer

elanoma

Top / Left to Right: Superficial Spreading Type – Superficial Spreading Type

Bottom / Left to Right: Lentigo Maligna Type / Regression of Melanoma

Types of Melanoma

  • Superficial Spreading
    • 70% of all Melanomas
    • Spreads along surface, before invading deeper
    • Irregular shaped, flat or elevated, multiple colors
    • Trunk, legs and upper back – most commonly involved areas
  • Lentigo Maligna
    • Very early Melanoma, with a good prognosis
    • Older age group
    • Face, upper trunk and arms
  • Nodular
    • Black nodule, usually invading deeply
  • Acral
    • Found on the palms of hands, soles of the feet and under the nails
    • Desmoplastic
    • Lacks pigment and can be a very aggressive Melanoma
  • Incidence
    • Highest in fair skin individuals & those with sun exposure

Prognosis

Pathological Classification by depth of penetration into the skin

Clark’s Level of Penetration

  • Level I – confined to Epidermis
  • Level II – penetrates the upper dermis or Papillary layer
  • Level III – fills the upper dermis or Papillary layer
  • Level IV – penetrates the lower dermis or Reticular layer
  • Level V – invades deeply into the fat

Breslow’s Classification – Based Depth of Invasion into the Skin

  • 0.75mm or less
  • 0.76mm to 1.50mm
  • 1.51mm to 4.0mm
  • 4.0mm or greater
  • 0.75mm or less = almost 100% survival for 10 years
  • Greater than 3.0mm = Poor Prognosis

Treatment

Surgical excision – wide, based on the depth of penetration

1-2-3 Rule

  • Remove a 1cm cuff of normal tissue on all sides of the Melanoma for penetration 1mm or less
  • Remove a 2cm cuff of normal tissue on all sides of the Melanoma for penetration 2mm or less
  • Remove a 3cm cuff of normal tissue on all sides of the Melanoma for penetration greater than 2mm

Sentinel Lymph Node Removal or Lymphadenectomy

Biopsy of lymph node(s) – First dye is injected into the skin surrounding the Melanoma to find the lymph node drainage. Then the 1st node in the chain is removed and analyzed. Lymphadenectomy (removal of all lymph nodes in the area) is done if there is involvement of the Sentinel node(s).

Radiation Therapy – generally done to relieve tumor symptoms.

Chemotherapy – systemic or local – used to control tumor spread.

Biological or Immunotherapy

  • Agents used to stimulate the Immune System
    • Block blood vessel formation
    • Directly attack the tumor cells
  • BCG ( Bacillus-Calmette-Guerin, TB strain ) or Vaccine
  • Interleukin 2 ( Lymphokines )

For skin cancer reconstruction surgery, call Dr. Costanzo at (805)373-9919

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