Melanomas are a type of skin cancer. They develop within the skin’s pigment cells and can soon spread to other areas of the body.
Discovering or suspecting you have a melanoma can understandably be extremely worrying. Below, we will answer some of the most frequently asked questions about melanomas and how they can be treated.
What is Melanoma?
Melanoma, referred to medically as Cutaneous Malignant Melanoma when arising on the skin, is a type of cancer commonly caused by sun exposure. When the skin is exposed to sunlight, our melanocytes (skin pigment cells) create more melanin. The melanin causes the skin to darken, giving you a suntan.
It is possible for the melanocytes to grow together in often harmless clusters, commonly referred to as moles. It is thought that the average person has around 10-50 moles on their body that are harmless.
Occasionally, melanocytes can become cancerous, causing them to multiply in an uncontrolled manner. They begin to invade the cells surrounding them and can travel to other parts of the body such as the lungs, liver and lymph nodes.
What is the cause of Melanoma?
The most common cause of melanoma is too much exposure to the sun’s UV rays. There has been evidence to suggest too much sun exposure within the first 20 years of life can contribute towards melanoma later on in adulthood.
Some people also have an increased risk of developing a melanoma such as those who burn easily in the sun and people who have over 50 moles on their body. There is also some evidence to suggest that it can be hereditary. Approximately 1 in 10 people who develop melanoma have a relative who has also experienced the disease.
In some cases, melanoma doesn’t cause any symptoms. However, early on you may experience itching and tingling around the affected area. You may also notice small changes within the skin, such as a change in size or colour of existing skin moles. As the cancer develops, the area will feel lumpy and hard, and it may crust or bleed.
Whenever you notice any of these symptoms, it is important to seek diagnosis as soon as possible.
How are Melanomas diagnosed and treated?
If you suspect you have a melanoma, book an appointment with your GP. They will be able to assess the area to see whether the changes could be down to something completely harmless. If they have any doubt over what it could be, they will refer you to a specialist.
Mr Myles Smith has extensive experience diagnosing and treating melanoma. During your consultation, he will examine the area and determine whether further assessment is needed. When it is needed, part of the suspected mole will be removed to be assessed within a laboratory. If a melanoma is discovered, it will be removed through surgery.
After you have had a melanoma removed, if you need a further excision, Mr. Smith will discuss your options with you, which may include sentinel node biopsy.
Although being diagnosed with a melanoma can be extremely scary, three quarters of patients who have them removed make a full recovery. The key is to ensure it is diagnosed and treated as quickly as possible.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital Clinics (Chelsea Outpatient Centre and Chiswick Medical Centre) or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden Hospital.
What is the Best Treatment for Melanoma?
Reality stars have recently been opening up about having moles removed in a bid to prevent them from getting skin cancer. Former Love Island star, Olivia Attwood, has become the latest to share her experience through social media, after having a mole removed from her back.
Removing moles that have changed can be an effective way to identify an early melanoma. The question is, what treatment options are available if you are unlucky enough to develop the cancer? Here, we will look at the best treatment method for melanoma.
Excision of the melanoma
Patients who have stage 1 or 2 melanoma, will usually be treated initially with a wide local excision. A local anaesthetic will be used before the melanoma is removed surgically.
If there is a likelihood that the surgery will leave behind a scar, that may cross a joint, or in an awkward place to close the wound, you may need a skin graft or flap.
Most of the time, once the melanoma has been removed with an excision surgery, it will not return. You will be monitored for up to 5 years after the treatment to ensure it doesn’t return.
Sentinel node biopsy
During an excision of the melanoma, the surgeon may also carry out a sentinel node biopsy. This helps to determine whether the cancer cells have spread throughout the lymphatic system. If it shows to have spread, you usually no longer need node dissection, but will need surveillance with ultrasound.
If you have melanoma in a lymph node, you will need staging scans, and should see a medical oncologist about whether treatments to reduce the risk of melanoma coming back are correct for you.
Optional clinical trials
If you are diagnosed with melanoma, you may be an ideal candidate for clinical trials that are currently being conducted.
You can talk to Mr Smith to determine whether you are suitable for any current clinical trials available where he practices. He will also be able to tell you more about them and how they work.
While it is important to diagnose and treat melanoma as quickly as possible, treatment options have come a long way. Even if you have been diagnosed with advanced melanoma, there are effective, potentially life-saving treatments available.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital Clinics (Chelsea Outpatient Centre and Chiswick Medical Centre) or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden Hospital.
Frequently Asked Questions About Melanomas
Melanomas are a type of skin cancer. They develop within the skin’s pigment cells and can soon spread to other areas of the body.
Discovering or suspecting you have a melanoma can understandably be extremely worrying. Below, we will answer some of the most frequently asked questions about melanomas and how they can be treated.
What is Melanoma?
Melanoma, referred to medically as Cutaneous Malignant Melanoma when arising on the skin, is a type of cancer commonly caused by sun exposure. When the skin is exposed to sunlight, our melanocytes (skin pigment cells) create more melanin. The melanin causes the skin to darken, giving you a suntan.
It is possible for the melanocytes to grow together in often harmless clusters, commonly referred to as moles. It is thought that the average person has around 10-50 moles on their body that are harmless.
Occasionally, melanocytes can become cancerous, causing them to multiply in an uncontrolled manner. They begin to invade the cells surrounding them and can travel to other parts of the body such as the lungs, liver and lymph nodes.
What is the cause of Melanoma?
The most common cause of melanoma is too much exposure to the sun’s UV rays. There has been evidence to suggest too much sun exposure within the first 20 years of life can contribute towards melanoma later on in adulthood.
Some people also have an increased risk of developing a melanoma such as those who burn easily in the sun and people who have over 50 moles on their body. There is also some evidence to suggest that it can be hereditary. Approximately 1 in 10 people who develop melanoma have a relative who has also experienced the disease.
In some cases, melanoma doesn’t cause any symptoms. However, early on you may experience itching and tingling around the affected area. You may also notice small changes within the skin, such as a change in size or colour of existing skin moles. As the cancer develops, the area will feel lumpy and hard, and it may crust or bleed.
Whenever you notice any of these symptoms, it is important to seek diagnosis as soon as possible.
How are Melanomas diagnosed and treated?
If you suspect you have a melanoma, book an appointment with your GP. They will be able to assess the area to see whether the changes could be down to something completely harmless. If they have any doubt over what it could be, they will refer you to a specialist.
Mr Myles Smith has extensive experience diagnosing and treating melanoma. During your consultation, he will examine the area and determine whether further assessment is needed. When it is needed, part of the suspected mole will be removed to be assessed within a laboratory. If a melanoma is discovered, it will be removed through surgery.
After you have had a melanoma removed, if you need a further excision, Mr. Smith will discuss your options with you, which may include sentinel node biopsy.
Although being diagnosed with a melanoma can be extremely scary, three quarters of patients who have them removed make a full recovery. The key is to ensure it is diagnosed and treated as quickly as possible.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital Clinics (Chelsea Outpatient Centre and Chiswick Medical Centre) or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden Hospital.
The Importance of Early Detection of Soft Tissue Sarcomas
Soft tissue sarcomas are a type of uncommon cancer that develops within connective or supportive tissues. These include muscles, tendons, fibrous and fatty tissue, blood vessels and nerves. They are most commonly found in the legs, arms and trunk of the body.
It is important to detect soft tissue sarcomas as quickly as possible, to access good quality care and reduce problems the tumour may cause. There are different types of soft tissue sarcomas and some will be more aggressive than others. For this reason, it is important to seek early detection to identify the type and severity of the condition, and to reduce the potential impact of treatment.
Here, we’ll look at why it is important to detect soft tissue sarcomas early and the treatments available.
Why is early detection important?
It is estimated that around 15 people are diagnosed with sarcoma each day within the UK. This means approximately 5,300 people develop them each year. There are over 100 different types of sarcomas, with soft tissue sarcomas being the most common.
Soft tissue sarcomas account for 88% of sarcomas in the UK. There are many different types including:
Whichever type of soft tissue sarcoma you have, early diagnosis is helpful.
Signs and symptoms to watch out for
If you stand any chance of diagnosing sarcomas early, you need to know the signs and symptoms to watch out for. These can vary depending upon the size and location of the tumour.
One of the first symptoms you may notice is a lump or swelling within the soft tissue. The lump may be getting bigger, and it is usually painful although not all patients experience pain.
Ideally, diagnosis should be provided when the lump is under 5cm in size. So, being aware of any lumps that develop and monitoring them for any change is going to help you to ensure you catch it early. The NHS recommends assessment of any lump that is greater than 5cm, deep, rapidly growing, painful or recurrent.
Diagnosis will typically consist of a physical examination, taking scans and a biopsy. Ultrasounds, MRIs and sometimes CT scans may all be used to diagnose a sarcoma.
How are they managed and treated?
Surgery is typically the most common treatment for soft tissue sarcomas, often with radiotherapy to reduce the risk of recurrence. Overall, outcomes are positive.
Several types of surgery can be carried out to treat these types of cancer, depending on the size and location of the tumour. The surgeon will go through your options and discuss which one would be better suited to you. It is important to understand the risks and complications involved with each type of surgery. The aim of surgery is to potentially cure the cancer, and certainly to control it at that site.
Overall, early detection of soft tissue sarcomas is helpful to ensure effective treatment. Watching out for the signs will help you to seek a diagnosis quickly. There are several treatment options available, with surgery being the most effective.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital Clinics (Chelsea Outpatient Centre and Chiswick Medical Centre) or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden Hospital.
Robotic Surgery Study accepted for publication in the Annals of Surgery
Mr Myles Smith and his colleague Mr Asif Chaudry, who work in the Oesophagogastric team of the Royal Marsden, were recently part of the first Upper GI International Robotic Association (UGIRA) Study Group project.
The Study investigated the worldwide techniques and outcomes of 856 Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) cases. This study follows work that Mr Smith and Mr Chaudry did into robotic surgery, and showed that RAMIE yields good outcomes on a global scale. It was accepted for publication in the Annals of Surgery (click here to access the article).
Robotic surgery is the next generation of Keyhole or Minimally Invasive Surgery, offering better visualisation, more operative flexibility, and expanding the benefits of keyhole surgery to more patients. The Robotic system is particularly suited for surgery for selected visceral sarcomas, such as GIST.
This landmark publication is a scientific milestone for UGIRA and provides directions for follow-up projects.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital Clinics (Chelsea Outpatient Centre and Chiswick Medical Centre) or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden Hospital.
Diagnostic Biopsy for GIST is safe
The question of whether one should perform a core needle biopsy for a suspected gastric or intra-abdominal GIST, or elect for surgery without preoperative diagnosis as a primary treatment, has long been debated. Mr Myles Smith of the Royal Marsden Hospital collaborated recently with Dr Willem Van Houdt of the Netherlands Cancer Institute in Amsterdam (NKI) to try to answer this question.
In their study ‘Oncological Outcome After Diagnostic Biopsies in Gastrointestinal Stromal Tumors’ published in the Annals of Surgery, they identified 228 patients with a median follow-up time of 53 months, who had a preoperative biopsy of their GIST between 1996 and 2014.
They found that only one patient developed a needle tract recurrence (1.4%), and multivariate analysis demonstrated that biopsy did not influence the rate recurrence or disease specific survival. Therefore, Mr Smith recommends considering a pre-operative biopsy where possible, for patients with suspected gastric or intra-abdominal GIST, as it appears to be safe, and we know that accurate preoperative diagnosis with molecular profiling may be of benefit in guiding treatment.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden.
Surgery for Rectal GIST in Europe
Mr Myles Smith was the senior author of the paper ‘Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort’ published in the European Journal of Surgical Oncology, which studied contemporary management of rectal GIST in Europe.
Rectal GISTs are rare tumours, and one of the achievements of this paper was to combine data for five databases, to create one of the largest series of cases published to date. The main findings were, that these challenging cases were treated with multiple modalities, but despite this, the recurrence rate was high after surgery.
The authors also found that aspects of care, were higher quality in specialist centres, such as a lower rate of tumour rupture at surgery. Therefore, the ultimate conclusion of this study was that referral to a specialist centre should be recommended for all patients with rectal GIST.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden.
Robotic surgery for gastric gastrointestinal stromal tumors
Mr Myles Smith has recently published his initial experience of using the Intuitive Da Vinci Surgical Xi System to operate on challenging gastric gastrointestinal stromal tumors GISTs in the Journal of Surgical Oncology.
The surgery was considered challenging, if the tumour size was >50 mm at the time of surgery and/or the location of the tumor was difficult to access. All GISTs were removed with clear margins, with no complications. The medial length of stay was two days.
Mr Smith and his colleagues concluded that using robotic surgery to remove challenging gastric GISTs seems safe, and may expand the benefits of a minimally invasive approach to more patients with GIST.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden.
Conservative margins may be enough for Dermatofibrosarcoma Protuberans (DFSP)
Mr Myles Smith was a co-author in two related publications which investigated the size of surgical excision margins needed to safely treat DFSP, and need for reconstruction. In the paper ‘Conservative Re-excision is a Safe and Simple Alternative to Radical Resection in Revision Surgery for Dermatofibrosarcoma Protuberans’, published in the Annals of Surgical Oncology by Mr Hayden Snow, the authors found that in the experience of the Royal Marsden Sarcoma Unit, a conservative re-excision of margins was a safe and acceptable compared to a traditional wide excision.
In another similar publication, which examined the adequacy of excision margins of DFSP in 3 specialist centres, Dr Huis in’t Veld and colleagues found that in specialist centres, the majority of patients had clear margins with one operation only, and that there was no improvement in the recurrence rate when the margins were greater than 1cm.
The conclusions of the study were that the wider the margins taken, the more likely one was to attain clear margins, with the trade-off being more frequent plastic reconstruction. Therefore, the width of excision margin taken to clear the DFSP must be balanced with the need for reconstruction, in the context that conservative excision is likely to be sufficient to remove the tumour and eliminate recurrence.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden.
Winner announced for Alfred Myles Bursary 2020
Ms Kathryn Hong is a UCD Graduate Entry Medicine student who carried out her SSRA project entitled TRANSFORMING THE ASSESSMENT OF CARDIAC FIBROSIS IN PATIENTS WITH ATRIAL FIBRILLATION in Toronto, during the summer of 2020. She was a finalist in the SSRA competition, and won the Alfred Myles Smith Bursary.
Her research was carried out at three sites: the Division of Cardiology at the Schulich Heart Centre, Sunnybrook Health Sciences Centre, and The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital both in Toronto ON, Canada as well as UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
Ms Hong, her supervisor Dr Benedict Glover, and her colleagues, developed a novel technique called omnipolar mapping which overcomes the limitations of current methods of mapping the cardiac fibrosis (scarring) that may initiate and propagate atrial fibrillation. Ms Hong hoped that the technique will help us gain a better understanding of the mechanisms underlying AF, and improve the overall success of catheter ablation treatment.
UCD School of Medicine
Summer Student Research Awards
(SSRA) 2020
Winning Abstract and Poster 2020
Alfred Myles Bursary 2020 Competition
People with anorectal melanoma may not benefit from radical surgery
Mr Myles Smith was recently interviewed by the National Institute for Health Research (NIHR) who issued an evidence report regarding his publication of a systematic review of radical surgery in patients with anorectal melanoma in the European Journal of Cancer (EJC).
This research guided part of the development of the UK guidelines for anorectal, and urogenital melanomas, which was supported by Melanoma Focus, and also published in the EJC.
For more advice, call us on 020 3770 5864 to arrange an appointment at the HCA Lister Hospital or call 020 7808 2785 to book a consultation with Mr Myles Smith at the Royal Marsden.