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The first step in diagnosing melanoma can be tricky. Not all melanomas are created equally and some don’t even look like a typical cancerous lesion. So it remains, that a biopsy must be performed in order to make the melanoma diagnosis.
A biopsy is surgically removing the mole or lesion, and examining it under the microscope. Though a variety of biopsy options are available, the punch biopsy remains the most common. With this procedure, a small circular portion around the mole is removed and sent to pathology for examination. At that point, the observations made of the mole will determine how large and how far advanced the melanoma is.
Melanoma cells reproduce in a disorderly fashion and take over like dandelions growing in a yard. These cells also grow in different directions like sideways and downward, When the melanoma grows sideways it is said to have radial growth. When the melanoma reaches down into deeper layers of tissue under the skin, it is spreading vertically. The latter poses the most danger and likelihood of metastasizing. This is what determines the classification of melanoma.
Breslow’s depth is how melanomas are measured in their depth of invasion into the body. The distance from the dermal-epidermal junction, the two layers of skin, to the most deeply invasive cells in the body is measured in millimeters. A melanoma which measures from 0 to 1.5 millimeters is considered confined to the skin and has the best survival prognosis. Greater than 1.5 millimeters can still be confined to the skin yet has a decreased survival rate. Beyond that measurement, the regional lymph nodes are involved and the actual depth of the mole isn’t as important. Once the melanoma is in the lymph system it poses a problem for spreading to other parts of the body. Distant metastases can also be any Breslow’s depth and involves melanoma cells having spread to other organs such as the lungs or brain.
Clark’s level is another measurement tool in diagnosing melanoma. A level I is confined to the dermal-epidermal junction and has not invaded into the blood or lymphatic vessels. Clark’s Level II the melanoma cells have spread into the next layer of skin, the dermis. A Level III has completely filled the dermis and a risk for spreading into the lymphatic system. Level IV melanoma has invaded the second layer of the dermis and the final level V has melanoma cells which have spread into the fat under the skin.
Staging is the next important step in assessing treatment for melanoma. The stages correspond with the Breslow’s depth and Clark’s level measurements. Stage I, the melanoma is confined to the upper layers of the skin. For Stage II, the cancer has spread into lower layers of the skin and potentially even below the skin. Stage III has cancer cells which have invaded the lymph nodes which drain the area of the primary lesion. And Stage IV involves metastases to internal organs, which drastically reduces the chance for survival.
Every melanoma patient will have a Breslow’s depth, Clark’s level and Stage of cancer. From that point, a physician can determine survival rates and what other procedures should be done.
Generally, someone with a melanoma less than 1.5 millimeters in depth and with no outward signs or symptoms of advanced cancer, a typical physical examination is performed and quite possible a baseline chest x-ray.
For primary melanomas from 1.5 to 4.0 millimeters in depth, a baseline chest x-ray is most definitely performed as are a complete blood count and blood tests which evaluate liver function.
Lesions greater than 4.0 millimeters require a sequential pattern of tracking the melanoma to determine where and how far the cancer has spread. The basics described above along with a lymph node biopsy and probably immunotherapy are in order.
Survival rates vary as to the depth of invasion of the melanoma, though that isn’t true for everyone. A 0.8 millimeter mole can spread throughout the body the same as a 4.0 millimeter mole can. But overall, the depth is a good indicator to survival rates.
Patients with a Level I mole have a 100 percent survival rate. Level II moles from 0 to 1.49 millimeters have a 90 percent survival rate. From 1.50 to 2.49 millimeters, survival rate is 60 percent. Between 2.50 and 3.99 millimeters, survival rate is 50 to 60 percent. Lesions greater than 4.00 millimeters range from 30 to 50 percent in survival.
The risk for a second melanoma is not very high, hovering between one and five percent, but it is worth remembering in follow-up visits with your physician. Without extra caution in watching moles for change, a secondary melanoma could occur and that decreases the survival rate yet again.
Age, gender and hereditary disposition also play a role in the survival rate of melanoma as does the location of the mole. So taking precautions to detect changes in moles is the first line of defense in surviving this dreadful disease.
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