UNDERSTANDING MELANOMA UNDERSTANDING CANCER TYPE Understanding Melanoma A guide for people with cancer, their families and friends JAN 2021 CAN726 For information & support, call 13 11 20 Understanding Melanoma A guide for people with cancer, their families and friends First published January 1996. This edition January 2021. © Cancer Council Australia 2021. ISBN 978 0 6489505 1 6 Understanding Melanoma is reviewed approximately every two years. Check the publication date above to ensure this copy is up to date. Editor: Jenni Bruce. Designer: Eleonora Pelosi. Printer: SOS Print + Media Group. Acknowledgements This edition has been developed by Cancer Council NSW on behalf of all other state and territory Cancer Councils as part of a National Cancer Information Subcommittee initiative. We thank the reviewers of this booklet: A/Prof Robyn Saw, Surgical Oncologist, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, NSW; Craig Brewer, Consumer; Prof Bryan Burmeister, Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD; Tamara Dawson, Consumer, Melanoma & Skin Cancer Advocacy Network; Prof Georgina Long, Co-Medical Director, Melanoma Institute Australia, and Chair, Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, NSW; A/Prof Alexander Menzies, Medical Oncologist, Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Paige Preston, Chair, Cancer Council’s National Skin Cancer Committee, Cancer Council Australia; Prof H Peter Soyer, Chair in Dermatology and Director, Dermatology Research Centre, The University of Queensland Diamantina Institute, and Director, Dermatology Department, Princess Alexandra Hospital, QLD; Julie Teraci, Clinical Nurse Consultant and Coordinator, WA Kirkbride Melanoma Advisory Service, WA. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title. This booklet is funded through the generosity of the people of Australia. Note to reader Always consult your doctor about matters that affect your health. This booklet is intended as a general introduction to the topic and should not be seen as a substitute for medical, legal or financial advice. You should obtain independent advice relevant to your specific situation from appropriate professionals, and you may wish to discuss issues raised in this book with them. All care is taken to ensure that the information in this booklet is accurate at the time of publication. Please note that information on cancer, including the diagnosis, treatment and prevention of cancer, is constantly being updated and revised by medical professionals and the research community. Cancer Council Australia and its members exclude all liability for any injury, loss or damage incurred by use of or reliance on the information provided in this booklet. Cancer Council Cancer Council is Australia’s peak non-government cancer control organisation. Through the eight state and territory Cancer Councils, we provide a broad range of programs and services to help improve the quality of life of people living with cancer, their families and friends. Cancer Councils also invest heavily in research and prevention. To make a donation and help us beat cancer, visit cancer.org.au or call your local Cancer Council. Cancer Council Australia Level 14, 477 Pitt Street, Sydney NSW 2000 Telephone 02 8063 4100 Facsimile 02 8063 4101 Email [email protected] Website cancer.org.au ABN 91 130 793 725 About this booklet This booklet has been prepared to help you understand more about melanoma, a type of skin cancer. Other types of skin cancer include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), which are often called non-melanoma skin cancers or keratinocyte cancers. Many people feel shocked and upset when told they have melanoma. We hope this booklet will help you, your family and friends understand how melanoma is diagnosed and treated. We also include information about support services. We cannot give advice about the best treatment for you. You need to discuss this with your doctors. However, this information may answer some of your questions and help you think about what to ask your treatment team (see page 51). This booklet does not need to be read from cover to cover – just read the parts that are useful to you. Some medical terms that may be unfamiliar are explained in the glossary (see page 52). You may also like to pass this booklet to family and friends for their information. How this booklet was developed – This information was developed with help from a range of health professionals and people affected by melanoma. It is based on Australian clinical practice guidelines.1 If you or your family have any questions or concerns, call Cancer Council 13 11 20. We can send you more information and connect you with support services in your area. You can also visit your local Cancer Council website (see back cover). Contents What is cancer? 4 The skin 6 Key questions 8 What is melanoma? 8 How common is melanoma? 8 What are the signs and symptoms? 9 What are the main types of melanoma? 10 What causes melanoma? 12 Why is sun protection important? 13 Which health professionals will I see? 14 Diagnosis 16 Physical examination 16 Removing the spot (excision biopsy) 17 Checking lymph nodes 17 Further tests 20 Staging melanoma 21 Gene mutation testing 22 Prognosis 22 Making treatment decisions 24 Treatment for early melanoma 26 Surgery (wide local excision) 26 Removing lymph nodes 30 Further treatment after surgery 32 Treatment for advanced melanoma 34 Key to icons Surgery 34 Icons are used Immunotherapy 35 throughout this booklet to indicate: Targeted therapy 36 Radiation therapy 37 Palliative treatment 38 More information Looking after yourself 40 Alert Protecting your skin 42 Personal story Understanding sun protection 44 Life after melanoma 45 Follow-up appointments 46 What if the melanoma returns? 46 Seeking support 47 Support from Cancer Council 48 Useful websites 49 Caring for someone with cancer 50 Question checklist 51 Glossary 52 How you can help 56 What is cancer? Cancer is a disease of the cells. Cells are the body’s basic building blocks – they make up tissues and organs. The body constantly makes new cells to help us grow, replace worn-out tissue and heal injuries. Normally, cells multiply and die in an orderly way, so that each new cell replaces one lost. Sometimes, however, cells become abnormal and keep growing. These abnormal cells may turn into cancer. In solid cancers, such as melanoma, the abnormal cells form a mass or lump called a tumour. In some cancers, such as leukaemia, the abnormal cells build up in the blood. How cancer starts Normal cells Abnormal cells Abnormal cells multiply 4 Understanding Melanoma Not all tumours are cancers. Benign tumours tend to grow slowly and usually don’t move into other parts of the body or turn into cancer. Cancerous tumours, also known as malignant tumours, have the potential to spread. They may invade nearby tissue, destroying normal cells. The cancer cells can break away and travel through the bloodstream or lymph vessels to other parts of the body. The cancer that first develops is called the primary cancer. It is considered localised cancer if it has not spread to other parts of the body. If the primary cancer cells grow and form another tumour at a new site, it is called a secondary cancer or metastasis. A metastasis keeps the name of the original cancer. For example, melanoma that has spread to the liver is called metastatic melanoma, even though the main symptoms may be coming from the liver. How cancer starts How cancer spreads Malignant cancer Cancer cells break away Cancer cells travel to lymph nodes and other parts of the body (metastasis) Grows own Invades blood vessels surrounding (angiogenesis) tissue Lymph vessel Blood vessel What is cancer? 5 The skin The skin is the largest organ of the body. It acts as a barrier to protect the body from injury, control body temperature and prevent loss of body fluids. The two main layers of the skin are the epidermis and the dermis. Below these is a layer of fatty tissue. The epidermis is the top, outer layer of the skin. It contains three main kinds of cells: Squamous cells – These flat cells are packed tightly together to make up the top layer of skin and form the thickest layer of the epidermis. These cells eventually die and become the surface of the skin. Over time, the body sheds these dead skin cells. Basal cells – These block-like cells make up the lower layer of the epidermis and multiply constantly. As they age, they move up within the epidermis and flatten out to form squamous cells. Melanocytes – These cells sit between the basal cells and produce a dark pigment called melanin, the substance that gives skin its colour. When skin is exposed to ultraviolet (UV) radiation, melanocytes make extra melanin to try to protect the skin from getting burnt. This is what causes skin to tan. Melanocytes are also in non-cancerous (benign) spots on the skin called moles or naevi. Most moles are brown, tan or pink in colour and round in shape. The dermis is the layer of skin that sits below the epidermis. It is made up of fibrous tissue and contains hair roots (follicles), sweat glands, blood vessels, lymph vessels and nerves. 6 Understanding Melanoma The layers of the skin Melanocytes Hair Squamous cells Epidermis Basal cells 4 mm Nerve 2– Dermis Sweat gland Hair follicle Blood vessel Fat layer Lymph vessel Muscle layer The skin 7 Key questions Q: What is melanoma? A: Melanoma is a type of skin cancer.