Melanoma is a more aggressive form of skin cancer which arises from the melanin cells in the skin. These cells are responsible for producing the pigment in the skin which results in a tan and are activated by ultraviolet radiation.
People with fair skin, blonde or red hair, blue eyes and lots of moles are at higher risk. There is an association with multiple childhood blistering burns. It is a much more aggressive cancer and has a worse survival rate. The cure rate is better with thinner melanomas that are discovered early. It usually requires 2 surgical procedures to remove the melanoma and needs a much wider margin of normal tissue around the cancer.
Warning signs include a skin lesion which has been present for more than 2 months and displays any of the following characteristics –
- any crusty, non-healing sores
- small lumps that are red, pale or pearly in colour
- new spots, freckles or any moles changing in colour, thickness or shape over a period of weeks to months (especially those dark brown to black, red or blue-black in colour).
The management of a complex skin cancer or melanoma requires assessment by a specialist from either the Plastic Surgical or Dermatology spheres. Most of the time the management is surgical although non-surgical techniques are appropriate in some situations. A referral to a plastic surgeon by either a general practitioner or dermatologist is usually because the cancer is in a cosmetically sensitive area or requires a specific type of reconstruction. The cancers are removed with a small area of surrounding tissue in order to get a clear margin around the tumour. The resulting defect that is left often cannot be closed directly and so necessitates a more complex reconstruction. This is in the form of a skin graft or transferring tissue around in the form of a local flap.