What is a Malignant Melanoma?

Malignant Melanoma is the most dangerous form of skin cancer. Malignant melanomas develop from moles or melanocytes (the pigment cells) in your skin. Malignant melanomas can develop from overexposure to ultraviolet radiation when too much time is spent in tanning beds or the sun, especially when not protected with sunblock. Malignant melanomas often look like normal or atypical moles. Like atypical moles, the majority of malignant melanomas have a black or dark brown coloration, but some can be a wide range of colors including skin colored, pink, red, white or even blue or purple, making their diagnosis challenging.

Early recognition of malignant melanomas is extremely important. When caught early they are generally curable, but if they are not, they may spread to other parts of the body (metastasis) making them far more difficult to cure. Malignant melanomas may appear anywhere on your body including areas where you cannot see such as on your scalp, your back, buttocks, and on the back of your thighs. As such, it is important that you are vigilant with examining your body routinely as well as with asking your skin doctor to perform a full body inspection annually (Please contact us at (949) 499-4147 to get your skin check today). It is important to monitor your skin regularly and become acquainted with all of your moles. Once you know all of the moles on your body be sure to check them (and any new lesions that might pop up) regularly for any changes with respect to the ABCDE’s of melanoma screening:


  1. Asymmetry: Draw a line down the middle of your lesion, check if appearance of one half does not match the other. If the two sides do not match then they are asymmetrical, which is a warning sign for a malignancy.
  2. Border Irregularity: Normal moles are typically very smooth and maintain even borders. If your lesion has uneven, blurred, or jagged borders it may be a malignant and should be checked by a medical professional.
  3. Color: Check the color of your lesion. Most normal moles tend to be a single shade of brown. If it has an uneven, two tone color variation, or if it is very dark, it may have transformed into an atypical or malignant mole. Remember, a malignant melanoma may also appear as a red, white, blue or purple spot.
  4. Diameter: Observe any change in size of your mole, any growth or mole larger than the size of a pencil eraser (about 6mm, or ¼ inch) should be evaluated by Dr. Mowlavi to rule out a malignant melanoma.
  5. Evolution: It is important to check your current moles for change or evolution. If there is any change in shape, size, color, as well as development of tenderness, itchiness, or bleeding (see symptomatic lesions) make an appointment with Dr. Mowlavi to have your moles assessed for the possibility of a malignant melanoma.

Treating Malignant Melanomas

Malignant melanoma is the leading cause of deaths caused by skin cancers. As such, the surgical treatment of malignant melanoma is extremely regimented. The surgical margins required for clearance of the tumor are determined by the depth of the lesion, which is why all suspicious pigmented moles that are biopsied should be biopsied by punch biopsy technique, in order to obtain the entire depth of the lesion. In conclusion, the depth of the melanoma determines the excision radius of normal skin that is recommended to be performed around the lesion. Recommended excision of tissue surrounding the skin, termed clinically clear margins, are presented below :


Depth of melanoma Excision radius of normal skin
in-situ 5 mm
< 1 mm 1 cm
1 to < 2 mm 1.5 cm
2 to 4 mm 2.0 cm
>4 2.0 to 3.0 cm

Closure of above defects are preferably performed in a straight line. When necessary, a circular defect must be extended into an elliptical defect (shape of an eye or football) in order to allow for closure in a straight line. When the skin surrounding the defect is too tight to allow for a straight line closure, a rearrangement flap is needed to fix the defect. Rearrangement flaps are created by making an assortment of back-cuts into the skin adjacent to the defect which then allows for stretching and moving of the skin to repair the defect created following clearance of your melanoma. Your plastic surgeon, Dr. Mowlavi, has performed over a thousand such flaps and will detail to you your expected results.

Since malignant melanoma lesions are notorious for skipping or metastasizing, it is prudent to perform a thorough examination of the lymph node regions. All patients are checked for regional nodal enlargement during their clinical examination. Patients with clinically enlarged nodes will require lymph node retrieval by your plastic surgeon, to rule out metastasis. For patients with melanoma lesions that are characterized as melanoma in-situ, there is no need for lymph node examination, as theses lesions by definition have not broken through a protective membrane (called the basement membrane) which protects against local or regional spread. For patients with lesions less than 1 mm in depth, excision alone with above excision parameters suffices. A chest X-ray and simple blood test suffices for checking for metastasis. For lesions measuring 1 to 4 mm and no clinically enlarged nodes, a PET SCAN is recommended to rule out metastatic disease. In addition, surgical removal of the closest draining node is required. This process is called Sentinel Lymph Node mapping and biopsy and will be performed on the day of your excision. Removal of this draining node closest to the mole of concern is critical to guide your postoperative treatment.

Patients with melanoma lesions greater than 4 mm in depth or those with nodes that are found to possess melanoma cells (determined by Sentinel Lymph Node mapping and biopsy, regardless of size of lesion) are placed on chemotherapy postoperatively. Chemotherapy regimens due vary but usually require 6 months of interferon therapy that will be guided by your oncologist.

Of note, above guides for surgical margins of excision, need for lymph node evaluation, and provisions for postoperative interferon therapy, are generalized recommendations and may be altered based on patient age, medical condition, and both clinical and microscopic analysis of the mole.


Images:


Malignant Melanoma 2 Melanoma Malignant Melanoma 1

How our patients feel about us:

As stress free as possible... Dr. Mowlavi and his staff did everything they could to make my experience as stress free as possible. The care that was provided prior, during and after surgery was exceptional. Both James and Dr. Mowlavi were available to answer my concerns and questions. I am very happy with the results.

Joyce J. Dana Point, CA

I am so happy with my results... I have had multiple skin cancer spots surgically removed by Dr. Mowlavi. I have been to several other doctors for the same procedure, and having met Dr. Mowlavi and his staff I have fought with my medical group to continue to send me to only Dr. Mowlavi. Not only is he understanding and explains the procedure from beginning to end but they make you feel as comfortable as possible. The entire staff is friendly and always on time for my appointments.

Kayla S. Laguna Niguel, CA

Fast, flawless, and painless... Dr. Mowlavi is a great doctor! I took my charge here twice for a skin cancer operation. Both surgeries were fantastic. They were fast, flawless, and painless. My charge had a similar operation from a different doctor prior to Dr. Mowlavi, and the surgeries were botched. It took forever for the wounds to heal, not to mention, it left an unsightly and indelible scar on my charges back. That is the reason why we had to use Doctor Mowlavi who finally did an amazing job! All I can say is that Dr. Mowlavi is a true expert on cosmetic surgery. He is very efficient in whatever he does. My charge is now very delighted of the outcome of his skin cancer operation.

Jon B. Anaheim, CA

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