Does melanoma need to be excised?

Written by Liu Gang
Dermatology
Updated on September 21, 2024
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Melanoma is a type of malignant tumor, which mostly develops from common melanocytic nevi. Once diagnosed with this disease, surgical removal is necessary. After the surgery, a full-body examination is also required to check whether the tumor cells have metastasized. If there is metastasis, further radiotherapy or chemotherapy is needed. If melanocytic nevi appear on the body, it is crucial to handle them properly, ideally by using laser treatment or surgical removal when they are relatively small to prevent the later formation of melanoma. If the melanocytic nevi cause pain, itching, or oozing after scratching, it might be a precursor to malignancy, and formal treatment is necessary.

Other Voices

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How to distinguish whether melanoma is benign or cancerous

Melanomas are always malignant; there are no benign melanomas. Benign lesions are called pigmented nevi, which are usually classified into three types: intradermal nevi, junctional nevi, and compound nevi. When a pigmented nevus becomes malignant, it is then referred to as melanoma. Therefore, in clinical practice, when we mention melanoma, we are referring to malignant melanoma. Malignant melanoma is staged based on the degree of invasion and whether it has metastasized. Treatment methods vary depending on the stage, and there are differences in treatment approaches. Therefore, if a pigmented nevus visibly enlarges over a short period, and shows symptoms such as ulceration, bleeding, or pain, it is necessary to promptly visit a reputable hospital's dermatology department for surgical removal, followed by a pathological examination.

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The significance of melanoma genetic testing

The significance of genetic testing for melanoma patients mainly involves two aspects: first, the identification of specific driver gene mutations to guide the application of targeted drugs; second, the detection of mutations in some common genes to judge the prognosis of the disease. Regarding the target gene mutations for drug selection, the commonly used ones include mutations in C-KIT, BRAF, and M-TOR. If mutations in these target genes are found, corresponding targeted drugs can be used for treatment. These drugs are generally orally administered, have relatively good efficacy, low side effects, and are suitable for the treatment of melanoma. Additionally, some genetic tests can predict the prognosis of melanoma patients based on the presence or absence of mutations.

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How long does it take for melanoma to develop from early stage to advanced stage?

From what we observe now, in the early stages of illness, melanomas are typically found on the extremities such as hands, feet, the underside of feet, under fingernails, and particularly on the big toe. Initially, they might appear simply as a black spot or a lesion. About two to three years later, there might be swelling at the site of the lesion or black spot. Then, within another five to six months, it may ulcerate, indicating that the condition has worsened.

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Does melanoma feel painful when pressed?

Melanoma is a highly malignant skin cancer, and clinically, some patients may experience pain when pressing on the lesion area. The reason for the pain is mainly due to the rapid growth of the melanoma, leading to compression of local tissues or the optic nerve and urgency, resulting in a painful sensation. This pain can exist even without pressing, and ulcerative lesions can occur in some affected areas, leading to symptoms such as pain, bleeding, and infection. In addition to pain upon local compression, patients with melanoma may also experience inflammatory changes such as redness, swelling, heat, and pain, causing some clinical symptoms of fever.

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Is amputation useful for melanoma?

Melanoma is a very terrifying disease. Once melanoma develops on the limbs, there is a tendency to favor as extensive a surgery as possible. It seems that the larger the excision, the cleaner it becomes, which helps to prevent future recurrence and metastasis. Even undergoing amputation surgery doesn’t necessarily eliminate the risk of metastasis and recurrence. Sometimes, if the margins of the excision are not beyond the range, the risk still exists. Therefore, the extent of the excision should be determined based on the patient’s condition.