Malignant Melanoma

Treatment

Standard treatment of melanoma is surgical removal of the suspicious spot soon in local anaesthesia. For melanomas there are safty margins known to be necessary, depending on the thickness of the melanoma, which is expressed in the tissue analysis result later. This makes a second excicion necessary, especially in case of an unexpected melanoma.

Example: if a melanoma is assumed to be less than 2 mm thick, it can be removed at once with 1cm safty margin. (valid for Germany)
For precursor melanomas (in-situ melanomas) 0.5cm is necessary.

For melanomas up to 2 mm tumor thickness 1cm margin is needed.

For melanomas with more than 2 mm thickness 2 cm safety margin is recommended.

For melanomas with more than 1mm thickness also the removal and examination of the sentinel lymph node is recommended, to be able to give an accurate prognosis and decide, if more treatment options are applicable.


In more advanced cases an adjuvant treatment e.g. alfa-interferon or other chemotherapy modalities sometimes are considered, but this is not a gereral rule and needs an expert doctor or a specialised clinic as a reference for the patient.


Known risk factors to develope melanoma are:

- fair coloured skin with, freckles and red coloured hair,

- easy sun burn

- persons with numerous moles, adults with more than 50 moles,

- severe sun burns in childhood,

- melanoma in first degree family members

Follow up

As for melanomas with less than 1mm thickness metastazation is not very likely, for follow up the full examination of the skin and of all moles is what is recommended (valid for Germany)
- twice a year in the first 5 years, after that once a year.
With tumor thickness above 1mm besides sentinel lymph node removal, ultrasound of local lymph nodes, chest x-ray and some blood tests are recommended: LDH, AP and S100. More details can be found in existing national guidelines .

Basal Cell Carcinoma

Treatment

A variety of treatment modalities are possible, but treatment of first choice is the complete surgical excision.

If an operation is not possible or being refused, there is radiation therapy, photodynamic therapy, Imiquimod cream for superficial cases, or 5-Fluor Uracil cream, cryotherapy with liquid Nitrogen or curettage.
Decision is made by the physician on individual factors and available means.
The recurrence rate that a BCC can grow back is still around 5% even with best treatment applied.

Follow up

Mostly recommend, the first follow up visit is after 3 month, than about twice a year and according to the type of BCC, type of treatment and the needs of the patient. There are no blood tests or x-rays useful. More details can be found in existing national guidelines.

Squamous Cell Carcinoma

Treatment test

Complete surgical removal is treatment of first choice. In some cases radiation therapy can substitute excision, if surgical thearpy is not possible. SCC on the lower lip and on oral mucosa, often found in smokers, are more agressive and need a more radical treatment. In persons with longlasting sun exposures and under immunosuppressive treatments (organ transplant) a high incidence and recurrence rate is possible and treatment might be difficult and unsatifying.

Ultrasound of regional lymphnodes may be useful in agressive or advanced cases, no bloodtests are indicative.

Follow up

Mostly recommend, the first follow up visit is after 3 month, than about twice a year and according to the type of SCC, type of treatment and the needs of the patient.
There are no blood tests or x-rays useful. More details can be found in existing national guidelines.