Re-excision (surgery)
After the diagnosis, a second operation follows in which the scar is removed more widely and deeply, to take away any remaining cancer cells and keep the risk of spread as small as possible.
Skin cancer & precursors
Medically reviewed by Dr. A.M. van Coevorden, dermatologist
± 4 min read
Melanomamalignant mole
Learn what a melanoma is, how to recognise it and which treatments are available. In plain language, based on the patient information leaflet from the NVDV.
What is a melanoma?
A melanoma is a potentially aggressive form of skin cancer that develops from pigment cells (melanocytes). In clusters these cells form a mole; in a melanoma they turn into cancer cells. In the Netherlands more than 7,000 are found each year, and it is becoming more common. Early detection and removal are very important, because a melanoma can grow into deeper skin layers and spread.
There are four stages:
- Stage 1: the cancer cells are very superficial in the skin.
- Stage 2: the cancer cells are deeper in the skin.
- Stage 3: the cancer cells are also in lymph nodes.
- Stage 4: the cancer cells are also in other places in the body.
How does a melanoma develop?
A melanoma can develop anywhere on the skin. Sometimes in an existing mole, but in about 70% of cases spontaneously on unblemished skin. Exactly why is not entirely clear. You are at greater risk if:
- one or more family members have had a melanoma
- you were often sunburnt at a young age
- you have used tanning beds a lot
- you have fair skin with red or light-blond hair
- you have more than 5 clinically atypical moles
- you have more than 100 moles
- you have a congenital mole of 20 cm or larger
- you have had a melanoma before
How do you recognise a melanoma?
Watch your skin and look out for the 'ugly duckling': a mole that looks different from the rest. Go to the dermatologist if:
- a new, striking light-brown, dark-brown, black or red spot suddenly appears
- an existing mole changes (grows, takes on several colours, becomes very dark or thicker, or changes shape)
- a mole hurts or bleeds
How does the doctor make the diagnosis?
The dermatologist can sometimes see a melanoma with the naked eye and uses a dermatoscope (hand-held microscope) for more detail. A suspicious spot is always removed under local anaesthetic (diagnostic excision) and examined by the pathologist. This makes it possible to say with certainty whether it is benign or malignant, and to determine the depth of growth (Breslow thickness) and any ulceration.
What treatments are available?
Sentinel lymph node biopsy
For melanomas of 0.8 mm or thicker (or thinner with ulceration), a surgical oncologist examines the nearest lymph node for spread, at the same time as the re-excision.
Medication treatment
If there is spread to the lymph nodes, additional targeted therapy or immunotherapy may follow. The medical oncologist carries out this treatment.
Spread (metastases)
A melanoma can spread. This usually happens through the lymph vessels to the lymph nodes in the neck, armpits and groin, felt as a firm lump under the skin. Spread can also travel through the blood to organs such as the liver, bones and brain. If you feel a thickened lymph node, have it examined.
What can you do yourself?
There is a lot you can do yourself to lower the risk and spot changes in time:
- Prevent sunburn.
- Do not use tanning beds.
- Know your own skin and check your moles at least 4 times a year, if needed with photos or help from someone else.
Frequently asked questions about melanoma
How do I recognise a melanoma myself?
Look out for the 'ugly duckling': a mole that looks different from the rest, or a spot that changes in size, colour, shape or thickness, or that starts to itch or bleed. If a spot does not feel right, make an appointment quickly.
How often should I check my skin?
Check your skin yourself at least 4 times a year, if needed with photos or help from someone else. Ask your dermatologist what suits your situation best.
Does a melanoma always develop from a mole?
No. In about 70% of cases a melanoma develops spontaneously on completely unblemished skin, and not in an existing mole.
Can a melanoma be cured?
The thinner the melanoma, the greater the chance of full recovery. With a thin melanoma without ulceration, the risk of spread is very small. Even when there is spread, there are now good treatments such as targeted therapy and immunotherapy.
Does sunscreen protect against a melanoma?
Preventing burning and avoiding tanning beds lower your risk, but never give a guarantee. So keep checking your skin, even if you protect yourself well from the sun.
Sources and more information
- NVDV patient leaflet on melanoma (nvdv.nl)
- Stichting Melanoom (stichtingmelanoom.nl)
- kanker.nl
- Huid Nederland (huidnederland.com)
Source: Dutch Society of Dermatology and Venereology (NVDV).