Melanoma is a term to describe all the forms of cancer that occur over the entire span of the body. It is a common misconception that melanoma can only occur on the surface of the skin. However, melanoma can occur inside the body as well, but is more prevalent on the surface of the skin.

In a quick search on the web, the term melanoma can be confusing, and sometimes terrifying. Dr. Jacobsen will be able to explain these issues to you simply and address any other concerns you may have.

It can be terrifying once you hear of a melanoma diagnosis. Despite the shock of a diagnosis, melanoma can be treated with surgery very quickly, and promptly. In most cases be identified and taken care of before the melanoma can spread any further.

Apart from other types of skin cancers, specific to melanoma, a wider margin of skin must be removed around the sighting to prevent future recurrence. In practice we say the melanoma must be removed with “clear margins”, in its entirety and can be seen and measured under a microscope. In some case the removal of a lymph node from the area may be required. The severity, or curability, of the melanoma is most directly related to its’ thickness in millimeters. Something called “Breslow’s Depth”. Dr. Jacobsen works closely with specialty oncologists to help in the overall care and follow up on your removal.

Once the area containing the melanoma is removed the wound must be closed as perfectly as possible, minimizing the scar and time it takes you to heal. One of the benefits of seeing a doctor who specializes in Cosmetic and Restorative Surgery is the precision and finely done repairs that are possible on your skin and body.

With many years of removing melanoma and professionally repairing the area, Dr. Jacobsen is an experienced melanoma specialist in Phoenix, and deals with it almost every day here at his practice.

Dr. Jacobsen and his staff realize how terribly important their skin is to their patients and how anxious patients may become, naturally, when they are informed that they have melanoma by their doctor or dermatologist. Dr. Jacobsen and his staff work close together to get appointments in as soon as possible and schedule very next day appointments. Having you treated as soon as possible.

When calling or emailing for an appointment, please make sure that you have your pathology report from your dermatologist or family doctor so we can design the best possible treatment for you.

Again, keep in mind the treatment for melanoma is 99.9% surgical. It is very unlikely the patient will need any other treatment except the surgery itself. Nearly every patient will require some sort of surgery to cure them of this terrible disease. The vast majority of patients who undergo surgery for melanoma do very well and it never recurs. It is only in patients with quite advanced melanoma that it tends to reoccur or become a life-threatening disease. Each patient needs a separate evaluation and unique surgical plan. Come see us and we will put your mind at rest, explain everything to you in detail and take excellent care of you.

Call or email us with you skin cancer question and we will help you.

Considering Your Options

With Phoenix consisting of warmer weather and hot sun, having or developing melanoma in Phoenix is not uncommon – and nothing to be ashamed of. Because of the common occurrences of melanoma in our city, Phoenix Melanoma Surgeons are regarded as some of the best in the world. If you think you have melanoma or think you’ve developed melanoma, it is important you see a specialist regarding your melanoma. Please feel free to refer to the rest of this page to learn more about melanoma and what you can do to work towards becoming melanoma-free. Keep in mind surgery is the treatment.

Surgery for Melanoma Skin Cancer

Surgery is 99% of the care needed for melanoma. Surgery is the primary cure for melanoma. All other treatments for melanomas fall after surgical treatment. There are rare exception to this, but these are indeed rare. The proper surgical excision of a melanoma is the most effective treatment possible for your melanoma.

Your Melanoma Pathology Report

The Melanoma Pathology Report is very difficult and technical to read. This can be very frightening, which is why Dr. Jacobsen will comfort and go over all the details of the report for and with you. Keep in mind the most important factor is the thickness of the melanoma. The melanoma thickness is expressed in millimeters. Generally, the melanoma the biopsy thickness is added to the melanoma thickness from the secondary removal. Dr. Jacobson will sort all this out with you.

Common Surgical Techniques for Phoenix Melanoma Removal Wide Excision

Melanoma should be treated with a wide excision. Normally with other skin cancers just removing a small amount of normal skin on either side of the cancer will be curative. However, with melanoma it is important to perform a wide excision, or what is called a “radical excision”, which means that you will need to have 1 cm or 2 cm more of additional skin around your biopsy area of the melanoma to be treated properly. This requires surgical reconstruction most times, which is why plastic surgeons and not dermatologist perform this treatment. Depending on the part of the body that is involved it can be difficult to remove the extra tissue, or this wide excision. Particularly if this occurs on the face. Normally, however, melanoma occurs on the extremities; the trunk or the scalp, but not the face. Melanomas rarely occur on the eyelids or the nose but, occasionally do on the lips.

Depending on the thickness of your melanoma you will need more or less tissue removed. If you have melanoma in “situ”, which is a pre-melanoma you may only need a small amount removed. Local anesthesia used on a small area can be removed in the office. Oftentimes, however, for larger resections this is done under light general anesthesia at the surgery center.

The removed sample is then evaluated by professional pathologists that specialize in melanoma skin tumors to determine that the melanoma is completely removed in its entirety.

Patients always ask if melanomas extend to the bone or not. Not only can melanoma effect the skin to the left and right of the tumor, but can also take particularly deeply down. Up until the muscular layer. Rarely ever touching the muscular layer, nerves, arteries or bones.

As a part of his practice, Dr. Jacobsen will draw on your body part exactly the amount that needs to be removed. The variability in the amount of skin that is removed is dependent on the thickness of the melanoma which Dr. Jacobson can review with you.

Mohs surgery

Mohs surgery is used for skin cancers but is not standardly used for melanoma. The main reason for this is that melanoma cannot be seen easily under the quick staining and microscopic procedures done in a Mohs surgeon’s office. To accurately see melanoma significant, specialized, staining techniques must be used under a microscope, sometimes taking up to 3 working days for results. The margins of Melanoma cannot be seen accurately with quick frozen sections that are required and done at the same time of the resection. As a result, Mohs surgery is not done for melanoma. Most dermatologists will refer melanoma patients to a plastic surgeon or to a general surgeon.

Amputation

In some situations, amputation can be a tool for cure of melanoma. This is quite rare however. It is only appropriate for quite advanced melanoma of the extremities, or for amputating the finger tips or digits that results from melanoma that has advanced under the fingernail, in the fingertip or toenails. Amputations are rarely required for melanoma.

Lymph node removal

In this operation, the surgeon removes all the lymph nodes in the region near the primary melanoma. For example, if the melanoma is on a leg, the surgeon would remove the nodes in the groin region on that side of the body, which is where melanoma cells would most likely travel to first. Once the diagnosis of melanoma is made from the skin biopsy, the doctor will examine the lymph nodes near the melanoma. Depending on the thickness and location of the melanoma, this may be done by physical exam, or by imaging tests (such as CT or PET scans) to look at nodes that are not near the body surface. If the nearby lymph nodes are abnormally hard or large, and a fine needle aspiration (FNA) biopsy or excisional biopsy will be able to test for melanoma in a node or nodes, before a lymph node dissection is usually done.

If the lymph nodes are not enlarged, a sentinel lymph node biopsy may be done, particularly if the melanoma is thicker than 1 mm. (See Tests for Melanoma Skin Cancer for a description of this procedure.) If the sentinel lymph node does not contain cancer, then there is no need for a lymph node dissection because it’s unlikely the melanoma has spread to the lymph nodes. If the sentinel lymph node contains cancer cells, removing the remaining lymph nodes in that area with a lymph node dissection is usually advised. This is called a completion lymph node dissection and is very rarely needed today. It’s not clear if a lymph node dissection can cure melanomas that have spread to the nodes and is still being studied. Still, some doctors feel it might prolong a patient’s life and at least avoid the pain that may be caused by cancer growing in these lymph nodes, but less than 4% of patients actually benefit from complete lymph node removal.

A full lymph node dissection can cause some long-term side effects. One of the most troublesome is called lymphedema. Lymph nodes in the groin or under the arm normally help drain fluid from the limbs. If they are removed, fluid may build up.This can cause limb swelling, which may or may not go away. If severe enough, it can cause skin problems and an increased risk of infections in the limb. Elastic stockings or compression sleeves can help some people with this condition. For more information, see our Lymphedema section. Lymphedema, along with the pain from the surgery itself, is a main reason why lymph node dissection is not done unless the doctor feels it is necessary. Sentinel lymph node biopsy, however, is unlikely to have the same effect. It’s important to discuss the risks of side effects with your doctor before having either of these procedures.

Postoperative Lymphocele

Some patient’s after the simple lymph node removal develop some fluid under their arm. This is called a lymphocele and can be drained very easily at Dr. Jacobson’s office with a small needle and a syringe. About 50% of patients develop this fluid collection after a sentinel lymph node biopsy for malignant melanoma or after the removal of a lymph node. Dr. Jacobsen will be following along very carefully with you. Some patients require 2 or 3 drainage visits, but most need none at all.

Surgery for Metastatic Melanoma

If melanoma has spread from the skin to other places in your body such as the lungs or brain, the cancer is not likely to be curable by surgery. Even when only 1 or 2 areas of spread are found by imaging tests such as CT or MRI scans, there are likely to be more metastases, too small to be found by these scans.

Surgery for Melanoma Metastases

Surgery is sometimes done in when there are metastases. This is intended in rare circumstances to control the cancer rather than cure it. If a limited number of metastases are present and can be removed completely, this surgery may help some people live longer. Removing metastases in some areas, such as the central nervous system, might also help prevent or relieve symptoms and improve a patient’s quality of life. But is very rare that surgery for distant melanoma tumor ormetastasis of melanoma response to surgery. Since immunotherapy now is so effective, surgical procedures for advanced melanoma is rarely necessary.

Treating Melanoma Skin Cancer

Once melanoma has been diagnosed and staged, your oncologist will discuss treatment with you. It’s important that you think carefully about your options. There are new options that are very effective now that we did not have available for patients just two years ago!

Which Treatments are used for Melanoma?

Based on the stage of the cancer and other factors, your treatment options might include:

• Surgery
• Immunotherapy
• Targeted therapy
• Chemotherapy
• Radiation therapy

Early melanomas can be treated with surgery alone. More advanced cancers often require other treatments. Sometimes more than one type of treatment is used. To read about the most common ways of treating these cancers, see Treatment of Melanoma Skin Cancer by Stage.

Which Doctors treat Melanoma?

Depending on your treatment, you may have different types of doctors on your treatment team. These doctors may include:

• A dermatologist: a doctor who treats diseases of the skin
• A plastic surgeon (or reconstructive surgeon): a doctor who uses surgery to treat cancer and is able to reconstruct at the same time
• A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy, immunotherapy, or targeted therapy
• A radiation oncologist: a doctor who treats cancer with radiation therapy

Many other specialists might be part of your treatment team as well, including physician assistants (PAs), nurse practitioners (NPs), nurses, nutrition specialists, social workers, and other health professionals. To learn more about who may be on your cancer care team, see Health Professionals Associated With Cancer Care.

Making Treatment Decisions

It’s important to discuss all of your treatment options as well as their possible side effects with your treatment team to help make the decision that best fits your needs. Some important things to think about include:

• Your age and health issues they may limit your ability to tolerate surgery
• The stage of melanoma
• The likelihood that treatment will cure your cancer (or help in some other way)
• Your feelings about the possible side effects from treatment

You may feel the need to make a decision quickly, but it is important to give yourself time to absorb the information you have just learned. It’s also very important to ask questions if there is anything you are unsure of. See What Should You Ask Your Health Care Team About Melanoma Skin Cancer? for some questions to ask.