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Questions to Ask Your Doctor if You Are Diagnosed With Melanoma

Melanoma is the deadliest form of skin cancer. Over 75,000 new cases of melanoma are diagnosed, and 9000 people die of melanoma each year. With these statistics, a diagnosis of melanoma can be very frightening. Knowing what questions to ask your doctor if you have been diagnosed with melanoma will enable you to make better choices about your care and treatment.

How Do You Know I Have Melanoma?

This question should be asked when you are told you have been diagnosed with melanoma. A diagnosis of melanoma cannot be made without a biopsy of your skin. Your doctor may feel that he or she is pretty confident that you have a melanoma by looking at a bad mole on the skin, but they cannot say for sure until a biopsy has been done. Therefore, a biopsy should have been done on a skin lesion your doctor thought was suspicious, and then sent to a pathologist who confirms or rules out a diagnosis of melanoma.

Should I Get A Second Opinion?

For a diagnosis as grave as melanoma, getting a second opinion may be a good idea. If your skin lesion has not been biopsied yet, then you can get another doctor to take a look at it and get the second opinion. If it has been biopsied and the diagnosis made, then your doctor can have another pathologist take a look at the biopsied mole. Most reputable physicians will not mind doing this for you.

How Severe is My Melanoma?

The severity of melanoma is determined by how deep it goes into the skin. There are two commonly used methods of describing this; Clark's level and Breslow level. Clark's level is a roman numeral system ranging from Clark's level I, which is the least serious, to Clark's level V, which means that the melanoma is invading levels below the skin. Because some skin is thicker than other areas, sometimes the Clark's level is not an accurate predictor of severity and another way of measuring the prognosis was developed called the Breslow system. The Breslow system is a direct measurement in millimeters of how thick the melanoma is. Measurements less than 0.75 millimeters are considered to have an excellent prognosis, while measurements of 4mm or more are serious.

What Stage is My Melanoma?

The staging of a melanoma is usually done during the initial treatment. The stage of a melanoma is an even more accurate prediction of prognosis than the Clark's level or Breslow measurement. The staging takes into account how deep the melanoma is, plus whether there are any lymph nodes that have melanoma in them or if there are any other distant areas of spread of the melanoma. It also takes into account whether there was any ulceration of the melanoma as well. Sometimes further testing in the form of CAT scans, PET scans or MRI scans, or blood work may need to be done to determine if the melanoma has spread to distant sites other than the lymph nodes. Stage I has the best prognosis, while stage IV is gravely serious.

What is My Prognosis?

The prognosis is usually discussed in terms of five year survival rates. Stage I, or Clark's level I or Breslow measurements less than 1 mm have a high five year survival rate of 97% or better. The higher the staging and Clark's level, and the thicker the Breslow, the five year survival rate decreases underscoring the importance of early detection and treatment. Stage IV melanoma has only a 7% to 19% five year survival rate.

What Are My Treatment Options?

After the initial biopsy and diagnosis, the initial treatment you will be offered will depend upon the Clark's or Breslow level. Most certainly, the melanoma will be surgically removed with an area of clear margin around it between five millimeters for thin melanomas, up to three centimeters for thicker melanomas. If the melanoma is at least 0.75 millimeters in thickness, you may have to have some of the lymph nodes draining the area biopsied. If the lymph nodes are discovered to be positive during the surgery, then you may need to have the entire area of lymph nodes removed. If there is evidence of distant spread, then various chemotherapeutic agents may be offered and you may have to see an oncologist or cancer doctor, to manage that part of your care.

Do I Need To Have My Whole Body Examined For Other Melanomas?

Having an initial melanoma does make the chance of you having another melanoma more likely. Therefore, it makes sense to have the entire skin surface examined. Even areas that have never been exposed to the sun need to be seen. After the initial diagnosis of a melanoma, this should be done at regular intervals, usually every three months for up to a year, then at a decreased frequency for the rest of your life. First degree relatives are also at an increased risk for melanoma and should be seen and have their entire body examined for possible melanomas.

Being diagnosed with a deadly cancer can be frightening. Knowing what questions to ask and what to expect for answers will usually result in better overall care. Most reputable physicians will welcome these questions and do not mind answering them for you. You have a right to know the seriousness of your diagnosis and what your treatment options are. For more information, go to Melanoma Research Foundation

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