Questions and answers

• How do I recognise a melanoma?

   It is important that a skin specialist such as a Plastic Surgeon see any lesion that an individual is concerned about. We particularly need to know if a skin mark has changed in colour, size or thickness recently. Melanomas tend to be dark or black skin marks with irregular borders and may have different colours within the boundary of the lesion.

• Is it common?

  New Zealand has one of the highest rates of melanoma in the world. This is due to the large amount of sunlight and weak ozone layer that NZ is exposed to. In 2008, melanoma was the sixth most commonly reported cancer with over two thousand new diagnoses.

• Who is at risk of getting a melanoma?

  There are certain skin types more susceptible to melanoma. Individuals with fair skin, light coloured hair and blue eyes are at greater risk than those with olive or dark skin.

• Diagnosing a melanoma?

  Dark lesions on the body can be hard to distinguish between those which are harmless and those which are melanomas. Clinical examination by a Plastic Surgeon can help to rule out clearly benign lesions such as seborrheic keratoses, however the only way to be certain whether a lump or lesion is a melanoma is to operate to remove it as a biopsy. The sample is then sent to the laboratory to be tested. If a melanoma is diagnosed then almost certainly more surgery will be needed to ensure that appropriate treatment has been completed.

• What are the different levels of melanoma?

  In the laboratory, the pathologist is able to diagnose a melanoma and look at particular features such as thickness to help with diagnosis and to guide further treatment.

  Melanoma-in-situ

  The earliest type of melanoma is called a ‘melanoma-in-situ’. This is a pigmented lesion where the melanoma cells have not yet obtained the ability to spread and has not invaded into the skin. To complete the appropriate treatment for this type of melanoma, a further margin of 5mm is required. Thicker melanomas can arise from an ‘in-situ’ lesions, in which case this changes the management.

  Thin melanomas

  Melanomas which have invaded into the skin to less than 1mm of thickness, are classified as being thin. Further surgery is required which usually involves a 1cm margin around the biopsy site. The exception to this rule is when there is ulceration present in the lesion or if there are other suspicious features. Your surgeon will discuss this with you. The risk of the melanoma spreading from this type of lesions is very low.

  Intermediate thickness melanomas

  Melanomas which are between 1 and 4 mm thick are classified as being intermediate thickness. Your surgeon may discuss with you the option of having a sentinel node biopsy which is an operation combined with a radioactive tracer to detect the first draining lymph node from a lesion. Whether or not a sentinel node biopsy is performed, further surgery around the biopsy site is required to ensure full clearance of the melanoma with the aim of preventing local recurrence.

  Thick melanomas

  Melanomas measured by the pathologist as being over 4mm in depth are known as thick melanomas. They have a higher recurrence rate than the other thinner lesions. Further surgery is required around the biopsy site to limit the chances of local recurrence and there may be a need for other tests to be performed.

• How do I know if a melanoma has spread?

  There are different features of a melanoma that can help us to determine the potential for a melanoma to spread. The size and thickness of the melanoma is important to guide whether further tests are required. This may involve special scans such as a CT or a PET scan or even further surgery. Your Plastic Surgeon will discuss the options with you.

• How can I prevent getting a melanoma?

  Sun protection is crucial. Even if you have had a lot of sun exposure in the past, it is possible to limit the damage from the harsh New Zealand sun by wearing a hat, clothing and sun screen. We have skin products available that can help to maximize this protection.

• Where can I find further information about melanoma?

  Information from the Ministry of Health about melanoma can be found at http://ebooks.nzgg.org.nz/melanoma_guideline/ - /1/

  Information from the American Joint Committee on Cancer on melanoma can be found at http://www.cancerstaging.org/staging/posters/melanoma8.5x11.pdf

  A free tool to help work out a patient’s prognosis from melanoma can be found at http://www.melanomaprognosis.org/

More detailed information can be obtained during a consultation with one of our plastic surgeons. Please contact the Institute for a consultation.

Pre and post operative photographs of all procedures are available to view at the Institute during your consultations.