Q: I’ve just been diagnosed with melanoma. What now?

A: Not all melanomas are the same and over 85% are curable.  Some behave in a benign manner and others in an aggressive way.  It is important to see a Melanoma specialist to ensure the correct treatment and advice is provided.

Q: What is the difference between a melanoma and a malignant melanoma?

A: There is no difference.  All melanomas are considered malignant. Malignant melanomas is an old term.  The modern term is melanoma.

Q: What’s a melanoma specialist called and how do I find a good one?

A: Melanoma is primarily a surgical disease when confined to the skin.  A melanoma specialist is someone who has spent time training at a melanoma centre and is an expert in the behaviour of specific types of melanoma and all management options. There are now very good guidelines as to how melanoma should be treated. Our specialists have access to the latest treatment and clinical trials. Your GP should refer you to the Melanoma Specialists.

Q: What does Breslow thickness and stages mean?

A: The ‘Breslow thickness’ of melanoma is the depth that the melanoma cells have grown into the skin.  This is measured by the pathologist in millimetres.  Your melanoma report should also list there the Clarke’s level, which is the anatomical layer in which the cells are seen (I-V), mitotic rate and ulceration.

The ‘stage’ gives some idea as to how far the melanoma has spread.  Stage 1 and 2 are confined to skin, Stage 3 to lymph nodes, and Stage 4 to distant sites from the primary.  There is often confusion between the Clarke’s level on the pathology report and the stage.  It is important to note that they are completely separate.

Q: What’s the difference between melanoma on the outside and melanoma on the inside?

A: Early stage melanoma is confined to the skin (outside).  Melanoma that has spread from the skin to lymph nodes or internal organs is more difficult to treat and therefore more serious (melanoma on the inside.)

Q: My doctor removed my melanoma but now I have to go back and have more taken away. Why can’t they get it right in the first place?

A: There are several reasons why you may be advised to have another surgical procedure. Usually the second operation is needed because the pathological examination from the first excision has provided further information to the guide the surgeon.  Needing another operation does not mean the surgeon was careless or negligent, quite the opposite in fact. The results of the biopsy are used to plan further treatment.

Q: What’s the new vaccine that I’ve heard can cure melanoma?

A: It’s important to understand that vaccine treatments in melanoma are experimental treatments. They are not the usual or standard treatments. Vaccine treatment of melanoma has been carried out for several decades, with varying results.  However there are new types of vaccines being developed, which are hoped will have improved results. Because melanoma vaccines are experimental, or investigational, they may not be freely available and may be available only as part of a clinical trial.

Q: I’ve heard about some people going to Australia for treatment. Why’s that? Should I go?

A: Yes, its true that some people with melanoma have travelled to Australian cities for treatment of melanoma. There are several reasons for this.

• The Melanoma Institute of Australia is a world-renowned centre with a well-deserved reputation for excellence. Many New Zealanders have heard about this centre and wish to have an option from the specialists there. Some of our Melanoma specialists have trained there.
• There are some treatments that have been available only in Australia. For example Medicare funds anti-CTLA4 and anti PD 1 antibodies, as does the UK and Canada.
• A number of clinical trials assessing new chemotherapy drugs are not available in NZ. Patients wanting access to these drugs usually have to go to Australia, although in some cases the drug can be sent to NZ.
• So, should a New Zealander with melanoma go to Australia for an opinion or for treatment?  In general the answer is “No”.  For most people diagnosed with melanoma, the treatment and prognosis is excellent, with equal results to those in Australia. Doctors in NZ can easily contact their colleagues in Australia for advice.
• Also, as doctors in NZ and Australia collaborated to produce a world-class guide to the treatment of melanoma that was published in 2008. There are now several melanoma specialists in NZ who have trained and worked at the Melanoma Institute of Australia/Sydney Melanoma Unit. These specialists have world-class expertise and will refer patients overseas if it is necessary.  If persons with melanoma are concerned whether they should go to Australia for a second opinion, they should ask our Melanoma Specialists. This includes the possibility to receive particular drugs or vaccines that may not be available in NZ.

Q: My workmate’s had 14 skin cancers removed and he’s absolutely fine. What’s all the fuss about?

A: There are many types of skin cancer. The most common are Basal Cell Carcinomas (BCC) and Squamous Cell Carcinomas (SCC). Almost all New Zealanders of European descent will get one in their lifetime.  Most are easily treated with excision (removal).  There is a risk of metastasis (spread) with aggressive SCC’s or in people whose immune system is compromised. The outlook depends on what type of skin cancer you have.

Q: I’m of Maori descent, I guess I’m pretty safe from developing melanoma?

A: While less than 1% of New Zealand’s melanoma is found in Pacific people, including Maori, it tends to be more advanced when its found. You should always be vigilant.

If you have any questions about Melanoma please contact the Melanoma Specialists.