Surgeon explains melanoma surgery
Вставка
- Опубліковано 4 жов 2024
- Surgical oncologist explains what melanoma is, what we need to know about it, and how we excise it from the skin. Melanoma skin cancer is the 5th most common cancer in the US. Melanoma is a skin cancer that comes from the melanin producing cells called melanocytes. These cells are in the lower layer of the skin and produce the pigment melanin that turns your skin dark. A normal mole is a cluster of non-cancerous melanocytes. Melanoma means that these melanin-producing cells have become cancerous. Melanoma is only 5% of all skin cancers. The other types of skin cancer such as squamous cell skin cancer and basal cell skin cancer are much more common but are not as dangerous. Risk factors for melanoma are having red hair/blond hair, green or blue eyes, and a history of multiple sun burns. It can happen at any age even in teenagers and young adults. Most melanoma grow from pre-existing moles. If a mole is changing with (A) for asymmetric margins (B) borders that are ragged (c) colors are different or changing or (d) diameter is more than a pencil-eraser and growing then this could be a sign of melanoma. A doctor will biopsy any concerning skin lesions with these characteristics. Once the suspicious mole is biopsied it is sent to a pathology doctor. The pathology doctor needs to tell us if the mole is a cancerous melanoma, and if it is a melanoma we want to know how deep it is growing down into the skin. We also want to know if the most superficial layer of skin over the melanoma is gone which is a factor called ulceration. Ulceration of a melanoma is a sign that is more aggressive so it’s a bad thing.
The most common form of melanoma is melanoma in-situ. In-situ means that the melanoma cells are stuck in the most superficial part of the skin and have not spread down into the skin layer. These tend to spread out in the skin and the edges can be very hard to see. (picture) Even though the melanoma cells have not grown deep, we still remove the full thickness of the skin down to the fat under the skin. Melanoma cells also spread out into the skin and we always want a margin of normal skin around a melanoma to be sure we also remove these few satellite cells. For melanoma in-situ we need to remove 5 mm from the visible edge of the melanoma. If the melanoma is about 1 cm in size, then taking 5 mm in every direction around it leaves a 2 cm hole. In order to close a hole in the skin that is 2 cm in diameter we can’t just stitch it together because the edges will lump up and it just won’t look good. Surgeons usually make an ellipse shape that is about 3x as long as it is wide and when we stitch this shut it will be a nice flat line. So for the 2 cm in diameter hole we make a 6 cm long elliptical excision.
The next form of melanoma is considered invasive down into the skin. If the depth of invasive melanoma is less than 1 mm from the surface of the skin this is called a thin melanoma. For a thin melanoma, we want to go 1 cm out from the edge of the visible melanoma in every direction. For a 1 cm in diameter melanoma, this means that the excision hole is 3 cm in diameter. The ellipse of skin removed to close this in a flat line is then 3 x as long so 9 cm in length. Any melanoma deeper than 1 mm and up to 4 mm in depth is called an intermediate thickness melanoma. Any melanoma deeper than 4 mm in depth is called a thick melanoma. The deeper a melanoma gets the more dangerous it is as far as the ability to spread or metastasize and regrow. But from a surgeon perspective, we usually treat intermediate and thick melanoma the same. We recommend removing 2 cm in every direction from the edge of the melanoma. These holes can get pretty big. For a 1 cm in diameter melanoma, a 2 cm margin in every direction will result in at least a 5 cm hole in diameter. We also recommend removing the entire thickness of the skin and the underlying fat tissue all the way down to the muscle underneath for these melanomas. To close the skin in a straight line for a 5 cm in diameter hole, the ellipse will be 15 cm long, this is 6 inches. This requires that we lift the skin up off it’s attachments to the underlying muscle for 5-10 cm off to the sides of the cut. This releases the tension so that the edges of the skin can be pulled together with stitches again. This leaves a large pocket under the closure.
Melanoma can spread to lymph nodes. Lymph nodes are part of your immune system and are attached to channels that lay just under the skin called lymphatic channels that carries lymphatic fluid. Melanoma deeper than 1 mm can have cells break off into the lymphatic fluid and get carried to the lymph nodes where they get stuck and grow. The technique to check the lymph nodes is called a sentinel lymph node biopsy and I have a separate talk on that you should check out. Anytime we have a melanoma deeper than 1 mm or a thin melanoma that is ulcerated we consider checking the sentinel lymph node biopsy.
6mm thick melanoma and 18 years later and I’m still here..
did you had the excision surgery?
@@muhammaduzzair8960I sure did
Correction 1:10 Most melanomas grow de novo, that is they grow where there is no pre-existing mole. Only around 25% grow from a pre-existing mole.
Thank you for sharing your time. Now that I've been diagnosed with M , my time is precious.
More people need to know about melanoma I'm battling it now I had melanoma in situ removed and having two other moles removed so glad I caught it early because of these videos it helps us know what we are looking for and helps our dermatologist spot it as well some people don't get so lucky and they don't find it early it is tricky if you have moles get checked out you might have melanoma and not know it I don't use tanning beds or lay out in the sun and I still got melanoma if cancer runs in your family like mine your high risk
Did you have to have a lymp nose study? Do you have skin grafts.
Please help me I have new moles in groin whether it is melonoma or not I don't know
Please anyone who has cancer get a box of baking soda and start alkaline in your body and studying everything you can because Otto Wahlberg Proved that Cancer CANNOT THRIVE in an ALKALINE PH ... He received a Nobel prize for his discovery... I know many people that have cured their own cancer with baking soda and potassium and magnesium powder..
DO YOU RESEARCH 🙏
Helpful video-thank you. Be careful friends-skin cancer is no joke. Be vigilant with your checks, stay safe.
A very clear explanation; thank you.
Extremely informative, thank you.
Excellent explanation and just what I was looking for. Thank you.
Excellent explanation.
stage 1a survivor here scary event 9 years ago on bottom of my foot
check your skin everywhere
That's odd in that the bottom the foot gets very little sun. I've had over 20 squamous lesions removed but thankfully no melanoma.
What I'm facing now
I just got diagnosed with it on the bottom of my foot
@@stacyshaughnessy4797me too, well next to my big toe.
bottom of your foot? how did you spot it?
Good information. Thank you.
Little correction: melanocytes are not located in the lower layer of the skin, normally they are in the stratum basale of the epidermis (which is the is the outermost of the three layers that make up the skin).
This is incorrect. Melanocytes reside in the stratum basale alongside basal keratinocytes. However, the stratum basale is the lower layer of the skin, just above the dermo-epidermal junction
Epiderme: córnea, camada granulosa, camada espinhosa e camada basal. A última camada e a basal. Ou seja, a camada mais abaixo.
Thank you. Very helpful.
Excellent explanation. Thank you
Please correct this. We no more do punch or shave biopsy, go for excisional biopsy with 2mm margin.
I just had shave biopsy a week ago, melanoma.....
Biopsy is the procedure that is used to remove a sample for histopathology. Excision is the procedure that removes the melanoma with a clear margin. Biopsies are still done. I had one done a week ago.
@@andysmith6218 The point is that the recommended biopsy when melanoma is suspected is for a full excisional biopsy. That means when you see a mole that you think could be melanoma, the best method to biopsy that mole is to remove the whole mole as a biopsy (excisional biopsy). This allows the pathologist to look at the whole mole left/right up and down to make the best assessment of it being melanoma or not. If you only do a small biopsy ( punch or shave) then the mole could be melanoma but the pathologist may not be able to tell.
Let's explain it this way. If you have a pizza, and I ask you to close your eyes and take a small bite out of one corner, you may not be able to tell that there is meat on the pizza because you didn't get any meat in your bite. So you say there is no meat when actually it is a meat pizza. This is the same as taking a biopsy of a mole you think may be melanoma, and missing the portion of the mole that is melanoma. Remember, melanoma can start within a mole, so not the whole mole is melanoma, and if you biopsy just a little bit, you may miss the melanoma portion and just get the normal mole. So the recommended method to biopsy suspected melanoma is to excise the whole mole as a biopsy ( excisional biopsy).
PS-one of the biggest areas of doctors getting sued concerning skin cancer is by the doctor taking a small sample biopsy, punch or shave, of suspected melanoma, which is then incorrectly judged not to be melanoma. The patient is incorrectly told the mole is not a melanoma and goes away, only to let the melanoma continue to grow.
Thank you
Well explained
Thank you for this
nice I had stage 1 thin melenoma removed .5 mill deep, Im getting more removed the 30th doctor said ill have a long scar
I need help I have this and it's on the side of my left knee. The plastic surgeon wanting to do it says it any be closed with sutures and he wants to leave an open wound or do a skin graft. This is all wrong, I want to find a specialized doc who will do the Mohs surgery. I need a great doctor I'm terrified
Call your health insurance company they will help you find a mohs surgery dermatologist mine was great at finding mine I had melanoma removed early and still getting more removed good luck to you
My scar is 5cm for an in situ.. Seems very small. Shall I be concerned?! My mole was 4mm originally
@@silentafterthought just to ad my narrow (original) excision left me with like 2cm scar. It wasn’t a straight line and one side had a bump. Not worried about the scar just worried that maybe my excision wasn’t big enough and I still have some cells somewhere
I hope things went well as it is 2 years since this post. 🙏🏻
What's difference with thin or stu melanoma??
What if no mole?
I just had a pink growth diagnosed as a melanoma. It’s atypical the doc and I thought it was squamous.
Salvestrol kills cancer also
Use it when you get skin cancer.
Does anyone else think that cancer treatment is a scam?