Melanoma Treatment Guidelines for Patients – Version III, September 2005

Introduction

patients have information on the way melanoma is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been written for the general public by the American Cancer Society (ACS). To obtain another copy of these guidelines, call the ACS at 1-800-ACS-2345, or the NCCN at 1-888-909-NCCN, or visit these organizations’ Web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

These patient guidelines will help you better understand your cancer treatment options. We urge you to discuss them with your doctor. You might start by asking the following questions:

• Where is my cancer located?
• How far has my cancer spread? What is the stage of my cancer? How does this stage influence my outlook for cure and survival and my treatment options?
• What treatment options do I have?
• What are the risks or side effects associated with each of my treatment options, and how are they likely to affect my quality of life?
• What should I do to be ready for treatment, reduce side effects of treatment, and hasten my recovery?
• What clinical trials are available for me?

In addition to these questions, be sure to write down some of your own. For instance, you might want more information about how long it will take you to recover from surgery so you can plan your work schedule. Or you may want to ask about clinical trials.

Making Decisions About Melanoma Treatment

The American Cancer Society estimates that around 60,000 new melanomas will be diagnosed in the United States each year. The number of new melanomas diagnosed in the US is increasing. Since 1973, the incidence rate for melanoma (the number of new melanomas diagnosed per 100,000 people each year) has more than doubled.

About 7,800 people in the US are expected to die of melanoma in 2005. Since 1973, the mortality rate for melanoma (the number of deaths from melanoma per 100,000 people each year) has increased. The good news is that melanoma mortality rates have only slightly increased during the past 10 years.

Although melanoma is a serious disease, it can be treated and cured. It is important that you receive care from a team of health care professionals who are experienced in treating melanoma. This team may include a dermatologist. a surgeon, medical oncologist, radiation oncologist, pathologist, nurse, radiologist, and social worker — often along with your primary care doctor.

The information in this website is intended to help you understand your options for treatment of melanoma so that you and your cancer care team can work together to decide which treatment is best for you.

At the end of this discussion, you’ll find flowcharts that doctors call “decision trees.” The charts represent different stages of melanoma, and each one shows how you and your doctor can arrive at the choices you need to make about your treatment.

To reach an informed decision, you need to understand some of the medical terms that your doctors use. You may feel you’re on familiar ground already, or perhaps you need to refer to the various sections listed on the front-page index. You will find not only background information on melanoma, but also explanations of melanoma stages, work-up (evaluation), and treatments — all categories used in the flowcharts. We’ve also provided a glossary. Words in blue italics are defined in the glossary; you can access their definitions in a small pop-up window by clicking on the word.

About the Skin

The skin has 3 layers called the epidermis, dermis, and subcutis. The top layer is the epidermis. The epidermis is very thin, averaging only 0.2 mm (about 1/100 of an inch). It protects the deeper layers of skin and the organs of the body from the environment.

The outermost part of the epidermis is called the stratum corneum, or horny layer. It is composed of dead cells of the epidermis that are continually shed. Below the stratum corneum are layers of living cells called squamous cells. These cells form an important protein called keratin. Keratin contributes to the skin’s ability to protect the rest of the body. The lowest part of the epidermis, the basal layer, is formed by basal cells. These cells continually divide to form new cells to replace the older ones that wear off the skin’s surface.

Melanoma comes from cells called melanocytes that are also present in the epidermis. These skin cells produce the protective pigment called melanin. Melanin gives a tan or brown color to the skin and helps protect the deeper layers of the skin from the harmful effects of the sun. The basal lamina separates the epidermis from the deeper layers of skin.

The middle layer of the skin is called the dermis. The dermis is much thicker than the epidermis. It contains hair follicles, sweat glands, blood vessels, and nerves that are held in place by a protein called collagen. Collagen, which is made by skin cells called fibroblasts, gives the skin its resilience and strength.

Below the skin is the subcutis. The subcutis and the lowest part of the dermis form a network of collagen and fat cells. The subcutis conserves heat and has a shock-absorbing effect that helps protect the body’s organs from injury.

Types of Skin Cancer

Skin cancers are divided into 2 general types: melanoma and nonmelanoma.

Nonmelanoma skin cancers (usually basal cell and squamous cell cancers) are the most common cancers of the skin. They are called nonmelanoma skin cancer because they develop from skin cells other than melanocytes. Because they rarely spread elsewhere in the body, they are treated differently.

Melanoma is a cancer that begins in the melanocytes, the cells that produce the skin coloring or pigment known as melanin. Because most melanoma cells still produce melanin, melanoma tumors are often brown or black. Although melanoma is much less common than basal cell and squamous cell cancers, it can be more dangerous. Melanoma, like basal cell and squamous cell cancers, is almost always curable in its early stages. However, melanoma is much more likely than basal or squamous cell cancer to spread to other parts of the body.

Melanomas can occur anywhere on the skin, but are more likely to develop in certain locations. The trunk is the more common site in men. In women, the legs are more commonly affected. Having darkly pigmented skin lowers the risk of being diagnosed with melanoma, but it is not a guarantee that you will not develop melanoma. Anyone, including people with dark skin, can develop this cancer on the palms of the hands, soles of the feet, and under the nails. Melanomas of the palms, soles, and nails represent about half of all melanomas in African Americans but fewer than 10% of melanomas in whites.

The entire report is also available as a PDF file:

NCCN_Melanoma_Guidelines.pdf 519k

You will need Adobe Acrobat to read this file.  Click here to download a current version.

EARLY DETECTION OF MELANOMA

The mutual goal of the National Comprehensive Cancer Network® (NCCN®) and the American Cancer Society (ACS) partnership is to provide patients and the general public with state-of-the-art cancer treatment information in understandable language. This information, based on the NCCN's Clinical Practice Guidelines, is intended to assist you in the dialogue with your physician. These guidelines do not replace the expertise and clinical judgment of your physician. Each patient's situation must be evaluated individually. It is important to discuss the guidelines and all information regarding treatment options with your physician. To ensure that you have the most up-to-date version of the guidelines, consult the web sites of the ACS (www.cancer.org) or NCCN (www.nccn.org). You may also call the NCCN at 1-888-909-NCCN or the ACS at 1-800-ACS-2345 for the most recent information.

NCCN Clinical Practice Guidelines were developed by a diverse panel of experts. The guidelines are a statement of consensus of its authors regarding the scientific evidence and their views of currently accepted approaches to treatment. The NCCN guidelines are updated as new significant data become available. The Patient Information version will be updated accordingly and will be available on-line through the NCCN and the ACS web sites. To ensure you have the most recent version, you may contact the ACS or the NCCN.

© 2005 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.