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What is known about why melanoma comes back after surgery?

Research on outcomes for melanoma patients

Most people who have had a melanoma have their melanoma removed and after surgery have no further trouble or recurrence of their cancer. Their prognosis (the likelihood of recurrence) is therefore excellent. For approximately 20% or 1 in 5 people, unfortunately recurrence does take place. If recurrence occurs then this is most commonly within a 5 year period, but rarely recurrences may occur many years later.

It is normal when reading information about cancers to feel scared, but for 80% of melanoma patients surgery will prevent further problems.

Why does recurrence occur?

The factors which lead to recurrence are mainly related to how thick the melanoma was at the time of surgery. This thickness is measured by the pathologist (the doctor who looks at the melanoma down the microscope) and it is known as the "Breslow thickness". There are some other signs which the pathologist will look for and the sum of these signs is used to "stage" the cancer. The staging system used after removel of the melanoma takes into account the thickness and whether the melanoma surface was ulcerated down the microscope. It also uses the result of a sentinel node biopsy if a patient agress to having this operation, which is a way of looking for spread of the melanoma to the draining lymph node (the glands nearest to the melanoma which is part of the immune system). Around the world the most common system used is the AJCC staging system.

People with thicker tumours or a higher AJCC stage are more likely to have a recurrence, because cancer cells are more likely to have spread to other parts of the body before the melanoma was cut out. Although the AJCC system is good, it is not perfect. Some patients with thin melanomas do have recurrences and some people with very thick melanomas, have no further trouble. 

Melanoma of the skin continues to be more common in many countries. The commonest type of melanoma occurs mainly in pale skinned people, especially those with skin which burns in the sun and those with more moles (melanocytic naevi) than average.

Rarer types of melanoma are those which grow under nails (subungual), on the sole of the foot, or the palms, or very rarely on the genitalia (mainly on the penis or vulva) and these types occur all over the world, in people of all skin colours and types. In any one country, the number of patients with these rare types of melanoma is small so that in order to make real progress in research we need to work together to make a difference. We hope that MyMelanoma will play a role here.

 

Research on outcomes for melanoma patients

Most people who have had a melanoma have their melanoma removed and after surgery have no further trouble or recurrence of their cancer. Their prognosis (the likelihood of recurrence) is therefore excellent. For approximately 20% or 1 in 5 people, unfortunately recurrence does take place. If recurrence occurs then this is most commonly within a 5 year period, but rarely recurrences may occur many years later.

It is normal when reading information about cancers to feel scared, but for 80% of melanoma patients surgery will prevent further problems.

Why does recurrence occur?

The factors which lead to recurrence are mainly related to how thick the melanoma was at the time of surgery. This thickness is measured by the pathologist (the doctor who looks at the melanoma down the microscope) and it is known as the "Breslow thickness". There are some other signs which the pathologist will look for and the sum of these signs is used to "stage" the cancer. The staging system used after removel of the melanoma takes into account the thickness and whether the melanoma surface was ulcerated down the microscope. It also uses the result of a sentinel node biopsy if a patient agress to having this operation, which is a way of looking for spread of the melanoma to the draining lymph node (the glands nearest to the melanoma which is part of the immune system). Around the world the most common system used is the AJCC staging system.

People with thicker tumours or a higher AJCC stage are more likely to have a recurrence, because cancer cells are more likely to have spread to other parts of the body before the melanoma was cut out. Although the AJCC system is good, it is not perfect. Some patients with thin melanomas do have recurrences and some people with very thick melanomas, have no further trouble. 

The Immune System

The immune system is very important to cancer patients as it is in infections and many aspects of health. The immune system can defend us from cancer as cancer cells are different to healthy cells. We know that the immune system is especially important in melanoma. It has been known for many years that where immune cells can be seen by the pathologist down the microscope in the primary melanoma, then the patient is less likely to suffer a recurrence of the cancer. More recently, the importance of melanoma in melanoma has become even more obvious, as melanoma patients respond particularly well to immunotherapies which work by taking off the brake to immune responses to the cancer. 

MyMelanoma will collect information from melanoma patients which will allow researchers to investigate these immune responses. The questions which are important to answer are:-

  • Why do some patients NOT mount an immune response to their melanoma and what could be done about it?
  • In patients who do show evidence of an immune response, why is that response not enough to kill the cancer cells, and how can that response be improved?
  • Is there a blood test which will tell us more about the immune responses present when a patient is diagnosed with melanoma, so that better treatment can be planned?
  • Are there lifestyle changes such as dietary changes which can boost the immune response?
What is known about why melanoma comes back after surgery?

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