More about melanoma
How and where is melanoma detected?
How does melanoma grow?
What is important to know before and after an operation?
What kinds of therapy are used?
What are the possible complications and side-effects?
How much does the operation cost?
Melanoma can occur on all parts of the body, there is no preference for sun-stressed skin regions. They can develop from pre-existing birthmarks or re-emerge on normal skin. Typically, melanomas do not cause any discomfort and are often only noticed by pigment enlargement, alteration, darkening, itching, wetting or bleeding.
Basically, melanoma can be called metastases, in other words, they form daughter tumors (they spread). The risk depends on the depth of penetration of the melanoma (this is determined very precisely in the microscopic examination) and lies between just over 0% and well over 50%. Since the risk for different patients varies widely, you need to be well informed about the situation you are experiencing. The surgeon will discuss this in detail with you.
The adjacent lymph nodes, the liver and the lungs are typical target structures that are examined by palpation and sonography or X-ray. This information is important to you as, after complete local removal of the melanoma, the primary treatment dermatologist or dermatology clinic will discuss further therapeutic options and steps with you. An example is adjuvant therapy.
In Germany, melanomas larger than 2 mm in penetration ("vertical tumor thickness") are recommended for treatment using interferon alpha immunotherapy, in addition to surgery ( this is an "adjuvant" therapy – additional therapy). Interferon alpha stimulates the body's own defense system to fight any remaining, invisible tumor cells. If you have been diagnosed with metastases (secondary tumors), your treating dermatologist or dermatological clinic will discuss with you the optimal and adequate treatment options.
A patient who has developed melanoma has a significantly increased risk of getting a second skin tumor, and there is a fundamental risk of metastasis. Therefore, careful physical examination prior to surgery (to detect any additional melanoma or abnormal birthmarks) and post-treatment care should be required from the referring dermatologist. In addition, you should monitor changes in pigment regularly and any pigment changes that you notice should be shown to your dermatologist.
Particular attention should be paid to the emergence of new pigmentation as well as the change of pre-existing pigmentation with regard to color, size and shape.
Requirements for melanoma surgery
• Diagnostics by a dermatologist (skin specialist)
• A general physical examination and so-called ’staging’
You have been diagnosed with melanoma, either due to the clear physical signs or it has already been confirmed by the referral physician through a tissue sample.
To minimize the risk of local reoccurrence, removal includes a ‘safe radius’ removal around the afflicted tissue. This safety distance depends on the penetration depth of the melanoma and is between 1 cm and 3 cm to the sides. Material is removed to the depth of the subcutaneous fat tissue. The surgeon will discuss the necessary scope of operations with you.
The closure of the wound takes place by stretching the surrounding skin, a skin shift (flap-plasty) or a skin graft. The appropriate surgical technique will be explained in detail before the operation.
Depending on the size of the necessary safety distance and the location of the melanoma, the operation is performed under local anesthesia, possibly supplemented by circulatory monitoring and / or the administration of tranquilizers, or in general anesthesia.
Pain can occur after surgery, but painkillers can control it well. Immediately after surgery, the surgical site is swollen, bruising may occur, and the wound dressings are conspicuous. This changes quickly within a short time. The wound care is performed by your surgeon. After the discharge, the referring physician can (partially) take care of the wound in your local area. The same applies to the removal of any necessary wound drainage and the stitches.
The scars resulting from the surgery become more and more inconspicuous in the course of time, in the ideal case you hardly see anything after a few months. If unsightly scars remain, then a correction surgery may be useful. The decision on this is usually only possible after 6 - 12 months.
The costs for diagnosed melanoma are usually covered by your health insurance provider.