Melanoma-in-situ

Patient Information

Introduction This leaflet has been written to help you understand more about Melanoma-in-situ. It tells you what it is, what causes it, what can be done about it, and how it can be prevented. It is not meant to replace discussion between you and your consultant, but to act as a guide to accompany what is discussed. What is melanoma-in-situ? Melanoma is a cancer of the pigment cells of the skin. It develops in the cells called melanocytes. These cells make the dark pigment called melanin, which gives the skin its natural colour. In- situ means that your lesion has been diagnosed at the earliest stage of development. All of the cancer cells are contained in the top layer of skin (also called the ‘epidermis’) and have not spread or grown into surrounding areas of the skin. It is extremely unlikely to spread to other parts of the body. There are two types of melanoma-in-situ, lentigo maligna and superficial spreading melanoma-in-situ. • Lentigo maligna usually presents as a flat brown freckle on the skin of the face or neck. They often grow slowly over several years and may be 1-2 cm in size or more. They are more common in people over 60 years old. • Superficial spreading melanoma-in-situ is usually less than 1 cm in size, a flat or slightly raised pigmented lesion, with a mixture of browns or dark brown or black in colour. It may occur anywhere on the body. What causes melanoma-in-situ? The most important preventable cause is exposure to too much ultraviolet light in sunlight, especially during the first 20 years of life. There is lots of evidence linking melanoma-in-situ to this and melanoma-in-situ is especially common in fair-skinned people who live in sunny countries. The use of artificial sources of ultraviolet light, such as sun beds, also raises the risk of getting a melanoma-insitu.

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People are more likely to get a melanoma-in-situ when: • They burn easily in the sun. This group of people is particularly at risk, melanoma-in-situ often occurs in fair-skinned people who tan poorly. Often they have blond or red hair, blue or green eyes, and freckle easily. • They have experienced past episodes of severe sunburn, often with blisters (particularly in childhood). However, not all melanomas are due to sun exposure and some appear in areas that are normally kept covered. • They have many ordinary moles (more than 50) or with a very large dark hairy birthmark. • They have many unusual (atypical) moles (known as‘dysplastic naevi’). They tend to be larger than ordinary moles and to have irregular edges or colour patterns. The tendency to have these ‘dysplastic naevi’ can run in families. • If another family member has had a melanoma. • They have already had one melanoma. How is melanoma-in-situ diagnosed? Melanoma-in-situ is diagnosed after the lesion or sample of it (biopsy) is surgically removed and examined in the laboratory. What is the treatment for melanoma-in-situ? Melanomas-in-situ are usually surgically removed under local anaesthetic. Some people, who have had a melanoma-in-situ removed, may need another operation to try to prevent the melanoma from coming back at the original site. During the operation, some healthy skin will be removed from around the original scarto reduce the chances of it coming back. This border is often called a ‘margin’ and is usually no more than 5mm wide. What are the alternative treatments? In most cases there is not any alternative to surgical removal. If melanoma-in-situ is not treated it is possible for it to develop into invasive cancer which can spread to other parts of the body. In a few cases, lentigo maligna may be treated with a course of Imiquimod cream applied to the area.

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Your doctor will be happy to answer any questions and concerns that you have about your recommended treatment. What happens after treatment? Often there is no further follow-up for melanoma-in-situ; in some circumstances your consultant may want to review your progress more frequently, this will be discussed at your consultation. Being diagnosed with any type of melanoma means you are at a higher risk than average of developing another one in the future. Because of this you should take extra care when in the sun, keeping yourself covered up and use a ’high protection’ sunscreen of at least SPF30 which also has high UVA protection. You may also be advised to check your body at regular intervals for any new moles or changes which could need further investigation. Your medical team or clinical specialist nurse will give you some more information about sun safety and about examining yourself. Glossary of medical terms used in this information: Epidermis: surface of the skin. Imiquimod cream: this cream uses the immune system to attack cancers. This means it uses the body’s natural defences to kill the cancer cells in the skin. It does this by releasing a number of chemicals called cytokines. One of these cytokines is called interferon. Interferon is a protein that is made naturally as part of the body’s immune response and is used as a cancer treatment. The idea is that the Imiquimod makes cells produce more interferon, and this then destroys the skin cancer cells. Lesion: a diseased or infected area of skin. Local anaesthetic: a medicine which causes a complete loss of feeling to a specific part of the body without causing you to lose consciousness. Melanocytes: cells located in the bottom layer of the skin’s epidermis and in the middle layer of the eye.

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For details of local cancer support groups and organisations, please ask your clinical nurse specialist. Local sources of further information You can visit any of the health/cancer information centres listed below: Birmingham Women's NHS Foundation Trust Health Information Centre Birmingham Women's Healthcare NHS FoundationTrust Metchley Park Road Edgbaston Birmingham B15 2TG Telephone: 0121 627 2608 Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: 0121 424 2280 Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: 0121 424 9486 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: 0121 507 3792 Fax: 0121 507 3816

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University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre University Hospital Birmingham NHS Foundation Trust Queen Elizabeth Hospital Edgbaston, B15 2TH Telephone: 0121 697 8417 Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: 0800 783 9050 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: http://www.birminghamcancer.nhs.uk. This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham Hospitals NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of British Association of Dermatologists (BAD) in producing this information (http://www.bad.org.uk). © Pan Birmingham Cancer Network 2009 Publication Date: December 2009 Review Date: December 2012 5