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Melanoma Archive Questions

Below are Dr. Hausner’s answers to Melanoma questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 29.

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Q : 1

I recently discovered a flat, irregular shaped mole on the bottom of my foot. I am a very fair-skinned female with a lot of moles already, but this one seems to have come up out of the middle of nowhere. Should I go have it checked, or watch for changes?

Pigmented lesions on the sole are uncommon and if changing might be dangerous. Surgery on the sole heals very slowly, so you should see a dermatologist to carefully assess the lesion.

Q : 2

Should I have second degree burns from 5-FU injections while treating squamous cell skin cancers?

It is not impossible, but you might be hypersensitive to the medication.

Q : 3

My friend has squamous cell carcinoma that has metastasized in the throat, sinus cavity and lungs. He has had radiation treatment that did not work. Do you have any other suggestions?

Your friend seems to have metastatic head and neck cancer. The only evidence-based treatment for this situation is chemotherapy.

Q : 4

Can melanoma elevate your white blood cell count?

Elevated blood cell count is usually due to infection. Some cancers do increase the white blood cell count by releasing growth factors, which stimulate the production of white blood cells. It would be extremely rare for melanoma to be the cause of your increased white blood cell count. Occasionally, with immunotherapy, a subset of white blood cells called lymphocytes might become more numerous in the peripheral blood.

Q : 5

Metastatic melenoma has caused tumors throughout the body being treated with stereotactic radiation therapy. They are only treating one tumor at a time. Can more than one be treated? Are nausea, vomiting, & headaches side effects associated with this treatment? No other treatment is being given. Had previous melanoma treated with surgery and interferon infusion.

Obviously, in metastatic melanoma, the disease is widespread, and cancer cells are all over the body, some of them multiplying and generating metastases. For this systemic disease (also called stage-IV) the treatment is systemic therapy: chemotherapy, immunotherapy or targeted therapy. Unfortunately, with the currently available drugs systemic therapy is often ineffective. Therefore, we occasionally rely on surgery and radiation even in patients with systemic disease. This makes sense if there is a limited amount of metastases and they have formed a long time after the primary cancer was removed. In the opposite case, just the tip of the iceberg is being removed to no big avail. This is what is most likely driving your doctors who carefully remove one lesion after the other, since you already most likely failed available systemic therapy. Stereotactic or gamma knife radiation has to enter through the skin and other parts of the body where it delivers a small amount of radiation to a big volume to achieve the goal, which is to deliver a large amount of radiation to a small volume. Therefore it is not totally without side-effects. Radiation can always cause nausea and vomiting.

Q : 6

I have a 4mm melanoma and it is unknown if there is any lymph node involvement. What would be the signs and symptoms of any metastases? Which organs can the melanoma spread to?

You seem to have a primary melanoma. The next structure likely to be involved are regional lymph nodes. These should be evaluated by a sentinel lymph node biopsy.

Q : 7

We are looking for information on aggressive digital papillary adenocarcinoma. Is this something you can help us with? I am inquiring on behalf of a 44-year-old male who had a biopsy taken from his left ring finger which was confirmed to be ADPD. WVU wants to do surgery soon to remove finger and test lymph nodes. As this is so rare, it's hard to find any information on it. Any suggestions you may have will be greatly appreciated.

Aggressive digital papillary adenocarcinoma is a rare tumor arising in the sweat glands. Since it is rare, there is not a lot of experience with different treatment modalities, but it seems obvious, that the adenocarcinoma (rather than adenoma) is pretty aggressive. It recurs very often, and metastasizes in a up to 10 percent of patients. Surgery, including amputation of a finger might be the best option. It is fast and would most likely represent definitive treatment. I do not know your age and profession to understand how bad an amputation would be for you, but redo surgery and spread of the disease would be worse.

Q : 8

I am a 33-year-old female, with many risk factors for skin cancer (fair skin, multiple sunburns as child, many atypical moles, etc). I was recently treated for melanoma in situ by surgical excision. Margins came back clean. I am also having two basal cell carcinomas removed with MOHS, and a moderately atypical mole removed from my leg. I am concerned because the majority of the moles (which are plentiful) on my body have asymetical borders, and the melanoma was removed did not present as a typical melanoma (in fact it had been missed by 2 other dermatologists). My doctors (dermatologist and surgical ongologist) have said that since it was melanoma in situ, no further treatment or testing is necessary. However, I am wondering if there is any additional testing that can be done (X-ray, bloodwork, CT scan, etc) to ensure that there is no additional melanoma in lymphs or other places. Do you have any thoughts?

Since the risk of spread from an in-situ melanoma is minuscule, no imaging studies would be helpful. The risk of false positivity is very high and the morbidity of working up such false positive results is also prohibitive. You should protect your skin from sunlight around noon. You should also watch your skin lesions. The most important factor to look for is change over time. The mole that is growing or otherwise changing is the dangerous one. Skin mapping would look for changing moles in a professional way.

Q : 9

I have just been told I have Mantle Cell lypmphocytic. It was found in a routine colonoscopy, three places in three different stages of growth. Do you study Mantle Cell? I just had a PET/CT scan waiting results.

Mantle cell lymphoma is a hematologic malignancy even though it presented in the large intestine during colonoscopy. The major thrust is going to be on chemotherapy. After you finish the staging procedures (PET/CT and other), you will need a Hematologist/Oncologist specializing in lymphoma to treat you. Recently, novel approaches are available for this type of lymphoma.

Q : 10

If diagnosed with Stage IV malignant melanoma, what, realistically, is one's life expectancy? There are mets in the lymph glands, on the lungs and there is a 2cm mass on the brain.

These is difficult to determine, since so many unknowns play a role. The most important is going to be the response to chemotherapy. You are most likely not a candidate for immunotherapy because of the brain metastasis. There are very interesting drugs on the horizon for a subset of melanoma patients whose melanoma cells carry a special mutation (V600E) in one gene (BRAF). This might be worthwhile knowing if there are appropriate trials available in your community.

Q : 11

A year ago I had a mole removed and biopsied that was negative, but I am still worried about developing melanoma. I lost a family friend to it years ago and notice similarities between him and I such as lots of sun exposure as a child, body hair that covers blemishes, etc. I am very worried about getting skin cancer, but can't afford to be monitored regularly. Is there something else I can do?

The best for you would be "mole mapping", for example a procedure called MoleSafe, which consists of taking multiple pictures of all of your skin with close-ups of all moles. This procedure is repeated about once every 6 months. Any change in size or appearance of moles can be acknowledged and growing lesions then removed. Growing lesions might be melanomas. A reasonable alternative is to take pictures of your skin with a digital camera and put them into a book, which you can take with you when you go for a skin exam by a dermatologist. Usually, melanoma is the mole that looks differently than the other ones - the "ugly duckling". Protect yourself from intensive sun-exposure from between 11 and 4 o' clock or by dressing up. The chance of getting a melanoma in ones life time is only about one in a hundred; do not let these worries ruin your life.

Q : 12

I had retnioblastoma as a child. Now, at 33, I have a pre-cancerous mole. Is there a relation between the two? Should I see an oncologist?

Yes, these two entities could be related. Retinoblastoma increases the risk of developing different cancers in the future. All of the cells in your body carry a mutation of the Rb gene, a tumor suppressor, and if such a cell loses the other copy of the gene, it might be prone to carcinogenesis. You have to watch yourself carefully and avoid sun exposure between 11:30 A.M and 4:30 P.M. If you find any new skin lesions, you should show them to a dermatologist immediately.

Q : 13

Is melanoma ever misdiagnosed as a skin infection and treated as such? Do dermatologists typically use the dermascope for diagnosing skin lesions suspected of being cancerous?

Melanoma is rarely misdiagnosed as a skin infection. Melanoma has different features and a different time line from most skin infections. The exception is an advanced and ulcerated primary melanoma which might be mistakenly considered to be a pyogenic granuloma. The dermascope is very useful for dermatologists who are trained to use it. It is commonly used in Europe, but lately the number of dermatologists using dermascopy is rising in the U.S.

Q : 14

My husband has been told that he has metastatic melanoma which was found during a heart scan. The PET scan showed several areas that varied in size, but no biopsy was performed. The treatment options that were proposed are chemotherapy including clinical trials or an autologous vaccine which would require removal of a lung nodule. However, there is a thoracic surgeon who is confident that he can remove the nodule with minimal damage to the lung. How can we be sure it's melanoma? Which treatment option is the best?

Your husband likely had a melanoma removed from his skin at some point in the past. If it was a long time ago, 3-5 years or more, and the metastasis is single, I would consider surgery. Otherwise, if he is in good shape, has normal kidney, liver, heart and lung function and is younger than 65, a high dose of interleukin 2 should be given because it carries the chance of cure. Unfortunately, most tumor vaccines have been proven to be harmful, rather than helpful and I would stay away from them. Chemotherapy might buy your husband time and quality of life, but it can not cure the cancer and should only be used if nothing else is available.

Q : 15

I have a dear friend who, in the last 3 months, has consistently manifested squamous cell cancers on his body. They have come in rapid succession, mainly 3-4 at a time, and when he goes to his skin specialist--at least 3 or 4 times a year, recently more--there are always biopsies to be done and at least half are squamous. Recently he has had up to 20 squamous--on his legs (with pigskin grafts), and other places, but mainly on his neck and face, forehead (with graft), and now on the top of his head. He can hardly recover from the Moh's before he is diagnosed with more. What can cause cancers like this to manifest in such rapid succession? And what action is appropriate, other than to continue Moh's-ing them off. Some have returned two and three times.

The reason for the relentless occurrence of squamous skin cancers is sun exposure that have done cumulative damage to the DNA of his skin cells over years and years of sun exposure. Avoiding sunlight is important. There might be a genetic predisposition e.g. a DNA repair defect. Alternatively, patient might be immunosuppresed as in patients post transplant. Actinic keratosis might be treated with imiquimod.

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