Cancer Care

Skin Cancer | Melanoma

Anyone can get skin cancer. It is the most common cancer type in the U.S. Those most at risk include people:

  • Who are in direct sunlight often
  • With a history of bad sunburns
  • With light-colored skin, eyes and hair
  • With a family history of skin cancer
  • 50 years or older
  • Who tan indoors

Early diagnosis is key to effective skin cancer treatment. 

What is skin cancer?

Skin cancer occurs when abnormal skin cells grow out of control and form tumors. The most common skin cancers are:

  • Basal cell carcinoma: Often found in sun-exposed areas like the shoulders, neck and head, basal cell carcinoma can come back if not removed completely. Patients who have had basal cell carcinoma are more likely to get it again.
  • Squamous cell carcinoma: Cells that are flat and constantly shedding, squamous cell carcinoma looks like open sores, scaly red patches or growths. When the cells become cancerous, they can slowly spread to other parts of the body if left untreated.
  • Melanoma: This very serious form of skin cancer can spread to other parts of the body and be deadly, if not diagnosed early. Early diagnosis is important for effective treatment.

MaineHealth  specialists offer comprehensive care for melanoma and other skin cancers. Services include early detection, diagnostic imaging, surgery, therapy and personalized treatment. Your care team may include:

  • Dermatologists screen for and diagnose skin cancer.
  • Medical oncologists treating melanoma use medicine (chemotherapy, targeted therapy, biotherapy and/or immunotherapy) to treat skin cancer.
  • Surgeons treating melanoma focus on the surgical management of the skin cancer.
  • Radiation oncologists use high energy X-rays to destroy cancer cells while sparing surrounding normal tissue.
  • Plastic and reconstructive surgeons  may perform surgery to remove the skin cancer while maintaining function and appearance.
  • Cancer Patient Navigators make sure you have everything you need to make informed decisions about your care.

Skin Cancer Screening and Self-Exams

Be sure to check your body for changes in your skin. Use the ABCDE rule for checking your moles:

A: asymmetrical (irregularly shaped)
B: border (the outer edges are uneven)
C: color (dark black or have multiple colors)
D: diameter (greater than 6 mm)
E: evolving (change in size, shape, and color)

Contact your provider if you notice a skin area that looks different.

Most common cancer symptoms

The most common skin cancer signs are skin changes:

  • New growth
  • Sore that does not heal
  • Change in a mole

Not all skin cancers look the same. Be sure to contact your health care provider right away if you see abnormal changes on your skin.

Early diagnosis is key to treating melanoma

Skin cancer screening starts with a physical evaluation of symptoms. Tests can be done to determine the presence of cancer and which type of skin cancer it could be. Skin biopsies, or samples, remove tissue from the lesion. The sample is looked at under a microscope and determined to be cancerous or non-cancerous.

MaineHealth physicians can recognize melanoma at its earliest stages. If you are concerned about a pigmented (dark or colored) lesion, make an appointment to see your family physician or a dermatologist. If it is suspicious, it can be removed and examined by a pathologist. When melanoma is diagnosed early, it can most often be cured with minimal treatment.

Mohs surgery is a common treatment for early stage skin cancer (melanoma). If the melanoma is very thin, it may be removed during the skin biopsy. Your doctor will remove the skin with cancer cells as well as a layer of healthy tissue around it.

  • Lymph Node Surgery: If the cancer has spread to lymph nodes, your surgeon may choose to remove those lymph nodes with cancer.
  • Chemotherapy: Chemotherapy drugs are used to kill cancer cells. The chemotherapy may be given through an IV or may be given in pill form.
  • Radiation: Radiation therapy can be used to kill cancer cells.
  • Biological therapy: Medications stimulate the body's own immune system to find and to fight the cancer.
  • Targeted therapy: With targeted therapy, medicine is tailored to attack genetic weaknesses in cancer cells.

Staging melanoma to determine treatment

After a melanoma diagnosis, your doctor will determine the stage of the cancer. This is an important step in the evaluation of melanoma. The melanoma size and stage will help decide treatment. Roman numerals I through IV (1-4) indicate how far the cancer has spread. Stage I is the earliest stage. At Stage IV, the melanoma has spread from your skin to other organs in your body.

Your cancer doctor will perform the following tests and look at the following factors to decide the size and stage of melanoma:

  • Tumor thickness: The melanoma will be measured and looked at under a microscope to determine the thickness. A special tool will be used to size it. In early stages the melanoma will not be thick. The thicker the melanoma gets, the greater the chance it has spread.
  • Sentinel node biopsy: This procedure lets your doctor know whether the cancer has spread to your lymph nodes. With a sentinel node biopsy, dye is injected into the site where the melanoma was removed. The first lymph nodes to collect the dye are removed and checked for cancer. If the lymph nodes are cancer free, it is unlikely the melanoma has spread to other areas in your body. 

Taking a team approach to treating melanoma

The treatment of melanoma should be by a multidisciplinary team of providers. At MaineHealth, team members include primary care physicians, your dermatologist, surgical oncologist, medical oncologist and radiation oncologist. For early cancers, having the mole removed with a wide edge can be the cure. Most often, mole removal is done right in your doctor's office.

More advanced disease treatment must be thoughtfully tailored to the individual patient.

  • For melanoma that is deeply invasive of the skin, a wider excision and evaluation of adjacent lymph nodes is imperative.
  • Lymph nodes can be evaluated with the procedure called sentinel lymph node biopsy. This procedure identifies lymph nodes that are most likely to contain metastases or spread of the tumor. This procedure not only identifies and treats melanoma in lymph nodes but can define future treatment.
  • Additional therapies can improve survival, control cancer, and treat metastatic disease. These therapies include chemotherapy, immunotherapy, radiation, targeted therapy, and clinical trials.

Getting a second opinion is not uncommon in cancer care. At the MaineHealth Cancer Care Network, we know how important it is to be confident in the approach to your skin cancer treatment. We want to make every effort to facilitate a second opinion, whenever the patient – and in many situations, the provider – wants to seek a second opinion. This is important to us, and our focus on patient-centered care.

What is a second opinion?

A second opinion is when a patient or physician seeks another physician specialist’s review of a patient’s diagnosis or recommended treatment. It is common in cancer, especially if a patient has an unusually complicated condition or rare form of the disease.

When you choose to obtain a second opinion after your melanoma diagnosis, your physician forwards test results such as radiology images, blood work and pathology slides. The physician may recommend another physician specializing in that cancer, or the patient may find a specialist through a primary care physician, online research or a relative or friend’s recommendation.

To confirm that insurance will cover the cost of second opinion visits, it is recommended that you verify by contacting your insurance company directly.

Preparing for your visit

Like all visits for cancer care, when you are getting a second opinion, it’s helpful to write down your questions in advance and take notes during the conversation. Physicians often recommend that you bring someone with you to help you recall the discussion later. It can be difficult to process what you’re hearing especially if you’re scared or anxious about your condition.

Physicians also may seek another physician’s opinion either on a one-on-one basis, or by asking a multidisciplinary group of cancer specialists to review and weigh in on a patient’s diagnosis or treatment. This team of specialists includes medical oncologists, radiation oncologists and surgical oncologists, as well pathologists, pharmacists and patient navigators. They meet regularly to review patient cases.

Where to go for a second opinion?

The MaineHealth Cancer Care Network offers the following sites where patients and their physicians may obtain second opinions. Each site includes skin cancer experts who have advanced training and experience.

MaineHealth Maine Medical Center

MaineGeneral Medical Center’s Harold Alfond Center for Cancer Care

Both adults and children need protection from too much sunlight.

  • Avoid direct sunlight.
  • Wear protective clothing that covers arms and legs.
  • Wear a hat and sunglasses that protect against UV rays.
  • Use sunscreen.