Stage 1 Melanoma (Thin)

Melanoma is a type of skin cancer that usually starts as a dark spot or mole on your skin. It is the most serious type of skin cancer and can spread to other parts of your body. However, if you find melanoma early, treatment works well and can lead to a cure. One of the most important causes of melanoma is exposure to too much ultraviolet light in sunlight.

The use of artificial sources of ultraviolet light, such as sunbeds, also increases the risk of getting a melanoma. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin coloured, pink, red, purple, blue or white.

Although a diagnosis of melanoma can be serious, most melanomas are caught at an early stage and so do not cause any further problems. If they are not caught at the early stages then there is a higher risk of the melanoma spreading, which can reduce life expectancy. You may hear this type of skin cancer called ‘malignant melanoma’, but it is often simply called ‘melanoma’.

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The only way a diagnosis of melanoma can be confirmed is to surgically remove the lesion. The specimen of skin is sent to a laboratory and a pathologist will examine it under the microscope. Pathologists look to see if what has been removed is a melanoma and how thick it is.

When the specimen is examined there are certain features looked at the give the melanoma a staging level. These include the thickness of the melanoma (called Breslow thickness), which measures how far the melanoma cells have invaded through into the layers of skin. The pathologist will also note other special features such as ulceration and pigmentation. This information is used as part of the staging process and according to this system you have been diagnosed with stage 1 melanoma. Stage 1 is considered a ‘thin melanoma’.

If your melanoma is caught before it is too thick the prognosis is very good. Nearly 19 in 20 people who have a stage 1 melanoma are alive at least five years after being diagnosed. Stage 1 is the least serious type of melanoma.

Surgical removal offers the best chance of a complete cure, and this treatment alone is usually successful in thin melanoma. Most patients do not need radiotherapy or chemotherapy.

Once a diagnosis of melanoma has been made you will usually be offered a second surgical procedure to remove more skin from around and beneath the melanoma scar. This second procedure typically removes a further 1cm margin of skin around the first scar site. It is called a Wide Local Excision (WLE) and is usually carried out under local anaesthetic. Your doctor will discuss with you how much skin will need to be removed as the recommended margin depends on the thickness of the melanoma. The purpose of this further surgery is to try and make sure that no cancer cells are left behind in the nearby skin.

Patients are routinely followed up in clinic after the completion of the WLE for three reasons:

• To check that the melanoma has not come back or spread
• To detect new melanomas or her skin cancers. To provide support, information and education

The follow-up plan should be agreed between you and your dermatologist and/or the surgeon who did the WLE. You will most likely see your doctor every three months, for between one and three years.