Thursday, May 23, 2013

Melanoma and Other Skin Cancers - Treatment for Other Skin Cancers

Table of Contents

A procedure called sentinel lymph node (SLN) biopsy is now recommended for cancers that are thicker than 1 millimeter. It is usually not necessary for cancers thinner than 0.75 millimeter, unless they have opened (ulcerated). Although some evidence suggests an SLN biopsy may improve survival, no clinical trials to date have proven that it improves the outlook in people with thin melanoma.

Sentinel node biopsy
Sentinel node biopsy is a technique that helps determine if a cancer has spread. When a cancer has been detected, often the next step is to find the lymph node closest to the tumor site and retrieve it for analysis. The concept of the "sentinel" node, or the first node to drain the area of the cancer, allows a more accurate staging of the cancer, and leaves unaffected nodes behind to continue the important job of draining fluids. The procedure involves the injection of a dye (sometimes mildly radioactive) to pinpoint the lymph node that is closest to the cancer site. Sentinel node biopsy is used to stage many kinds of cancer, including melanoma.

An SLN biopsy involves the following:

  • A tiny amount of a tracer, either a radioactively labeled substance or a blue dye, is injected into the tumor site.
  • The substance flows through the lymph system into the sentinel node, the first lymph node to which any cancer would spread in a given area.
  • The sentinel lymph node and possibly one or two other nodes are removed and biopsied.

The results of the biopsy can help doctors decide whether or not to remove other lymph nodes:

  • If the sentinel node and other nodes show signs of cancer, the nearby lymph nodes are removed.
  • If they do not show signs of cancer, the rest of the lymph nodes will likely be cancer-free, and further surgery is not needed.

Secondary Tests

Patients with nom-melanoma skin cancers generally require no further workup.

Those with melanoma may need the following:

  • Blood tests that examine the levels of the enzyme lactate dehydrogenase. Elevated levels of this enzyme suggest that the cancer has spread.
  • Blood tests to assess liver function and other factors, such as anemia. These tests help determine specific sites where the cancer may appear.
  • Computed tomography (CT) scans of the chest, abdomen or pelvis, which may be used to identify whether the melanoma has spread at the time of diagnosis. These scans are also used to monitor the patient after treatment.
  • Positron emission tomography (PET) may also be used. PET may help find evidence that the cancer has spread elsewhere in the body. Such evidence does not always show up during a physical exam or CT scan.

Review Date: 07/04/2010
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)