Your Biopsy Result
Your skin biopsy has shown melanoma, a type of skin cancer.
We understand that hearing the word “cancer” can be frightening. Many patients feel shocked, anxious, or overwhelmed when they receive this diagnosis.
The good news is that most melanomas can be successfully treated when they are found early and removed completely. Modern treatments have also greatly improved outcomes for patients with more advanced melanoma.
This Handout Explains
- What melanoma is
- Why it develops
- The different stages of melanoma
- Why surgery is urgently needed
- What additional tests may be required
- What happens after surgery
- Your long-term outlook
- How to reduce your future risk
What Is Melanoma?
Melanoma is a cancer that starts in melanocytes, the cells that produce the pigment (melanin) that gives your skin its colour.
Normally, melanocytes grow in an orderly and controlled way.
Sometimes, however, damage to their DNA causes these cells to grow uncontrollably. Over time, they can become cancerous and develop into melanoma.
Unlike many other skin cancers, melanoma has the ability to spread (metastasize) to other parts of the body if it is not treated promptly.
For this reason, melanoma is considered the most serious type of skin cancer.
Why Does Melanoma Develop?
Melanoma usually develops because of a combination of several factors.
1. Ultraviolet (UV) Radiation
The most important cause is repeated exposure to ultraviolet (UV) radiation from:
- The sun
- Tanning beds
UV rays damage the DNA inside skin cells. Although your body repairs much of this damage, repeated exposure over many years allows mutations to accumulate, increasing the risk of melanoma.
Even severe sunburns that occurred during childhood can increase the risk decades later.
2. Fair Skin
People with:
- Fair skin
- Light-coloured eyes
- Blond or red hair
- Freckles
have less natural protection from UV radiation and are at higher risk.
3. Large Numbers of Moles
People who have many moles, especially atypical (dysplastic) moles, have an increased risk of developing melanoma.
4. Family History
If close relatives have had melanoma, your own risk may be higher.
5. Previous Melanoma
Once someone has had melanoma, they have an increased chance of developing another melanoma later in life.
This is why lifelong skin examinations are essential.
Is Melanoma Dangerous?
Yes.
Melanoma can become life-threatening if it is allowed to grow and spread.
Unlike many other skin cancers that usually stay where they start, melanoma cells can travel through:
- the lymphatic system
- the bloodstream
They may spread to:
- lymph nodes
- lungs
- liver
- brain
- bones
- other organs
Once melanoma spreads, treatment becomes much more complicated.
The goal is to remove melanoma before it has a chance to spread.
Why Is Surgery Needed Urgently?
The biopsy has confirmed that melanoma is present.
Although the biopsy removed part or all of the visible lesion, microscopic melanoma cells may still remain in the surrounding skin.
These remaining cells could continue to grow if they are not removed.
For this reason, additional surgery (called a wide local excision) is almost always required.
The surgery removes:
- the biopsy scar
- a margin of healthy-looking skin around it
This ensures that any remaining melanoma cells are removed.
Because melanoma has the potential to spread, this surgery should be arranged as soon as reasonably possible, usually within a few weeks of diagnosis, according to your treating surgeon’s and dermatologist’s recommendations.
Prompt treatment offers the best chance of cure.
Understanding the Stages of Melanoma
Melanoma is staged according to how deeply it has grown into the skin and whether it has spread elsewhere in the body.
The stage helps determine the most appropriate treatment and gives an estimate of prognosis.
Stage 0 (Melanoma in Situ)
This is the earliest possible stage.
The melanoma cells are found only in the outermost layer of the skin (the epidermis).
They have not invaded deeper tissues.
At this stage:
- it cannot spread elsewhere in the body
- surgery is usually curative
- the cure rate is extremely high (approaching 100% with complete excision)
Although Stage 0 is the least advanced form of melanoma, it still requires complete surgical removal because it can progress to invasive melanoma if left untreated.
Stage I
Stage I melanoma has grown into the deeper layers of the skin but remains relatively thin.
It has not spread to lymph nodes or other organs.
Treatment usually involves:
- wide local excision
- occasionally a discussion about whether a sentinel lymph node biopsy is needed, depending on the tumour thickness and other high-risk features
The prognosis remains excellent, especially when treated early.
Stage II
Stage II melanoma is thicker and has grown deeper into the skin.
Although it has not yet spread to lymph nodes, the risk of future spread is higher than in Stage I.
Treatment usually includes:
- wide local excision
- sentinel lymph node biopsy in many patients
- close follow-up
Some patients may also benefit from additional treatment after surgery, depending on the final pathology results.
Stage III
Stage III melanoma means the cancer has spread to nearby lymph nodes or to small deposits of melanoma in the skin or lymphatic channels near the original tumour.
Treatment may include:
- surgery
- removal of involved lymph nodes in selected situations
- immunotherapy
- targeted therapy (for patients with specific genetic mutations)
- regular imaging studies
Many patients with Stage III melanoma can still be treated successfully, particularly with today’s newer medications.
Stage IV
Stage IV melanoma means the cancer has spread to distant organs such as:
- lungs
- liver
- brain
- bones
- distant lymph nodes
Treatment usually involves:
- immunotherapy
- targeted therapy (if appropriate)
- radiation therapy in selected cases
- surgery in certain situations
- participation in clinical trials when appropriate
Over the past decade, major advances in treatment have significantly improved survival for many patients with advanced melanoma.
What Is Breslow Thickness?
Your pathology report may mention Breslow thickness.
This is one of the most important measurements in melanoma.
It measures how deeply the melanoma has grown into the skin.
In general:
- thinner melanomas have a better prognosis
- thicker melanomas have a greater chance of spreading
Breslow thickness helps determine:
- the stage of the melanoma
- how much skin needs to be removed during surgery
- whether a sentinel lymph node biopsy should be recommended
What Is Ulceration?
Some pathology reports mention ulceration.
Ulceration means the skin covering the melanoma has broken down.
Ulcerated melanomas tend to behave more aggressively and may increase the stage of the cancer.
What Is a Sentinel Lymph Node Biopsy?
Some patients require an additional procedure called a sentinel lymph node biopsy.
The lymphatic system acts as part of the body’s drainage and immune system.
Melanoma cells usually spread first to the nearest (“sentinel”) lymph node.
During surgery:
- a special dye and/or radioactive tracer identifies the first draining lymph node
- this lymph node is removed
- it is examined carefully for microscopic melanoma cells
If no melanoma is found in the sentinel lymph node, it is reassuring and suggests the cancer has not spread through the lymphatic system.
Not every patient requires this procedure. Whether it is recommended depends on factors such as the Breslow thickness and other features of your melanoma.
What Happens After Surgery?
After your wide local excision:
The removed tissue is sent to the laboratory.
The pathologist confirms:
- all melanoma has been removed
- surgical margins are clear
- the final stage of the melanoma
- whether any additional treatment is needed
Many patients require no further treatment beyond surgery, particularly those with Stage 0 or Stage I melanoma that has been completely excised.
Will I Need Chemotherapy?
Traditional chemotherapy is now used much less often for melanoma.
Instead, modern treatments such as immunotherapy and targeted therapy are used for selected patients with higher-stage disease because they are generally more effective.
Most patients with early-stage melanoma do not need these treatments after complete surgical removal.
Will Melanoma Come Back?
Most patients treated for early-stage melanoma never experience a recurrence.
However, melanoma can occasionally return:
- in the surgical scar
- nearby in the skin
- in lymph nodes
- elsewhere in the body
This is why regular follow-up is extremely important.
Will I Need Regular Skin Checks?
Yes.
After one melanoma, you have an increased lifetime risk of developing another melanoma.
Your doctor will recommend regular full-body skin examinations. The frequency depends on your stage and individual risk factors, but visits are commonly scheduled every 3–12 months initially, with the interval adjusted over time.
Between visits, you should examine your own skin once a month and report any new or changing lesions promptly.
Protecting Yourself from the Sun
Reducing future UV damage is one of the most important things you can do.
Every day:
- Use a broad-spectrum sunscreen with SPF 30 or higher.
- Reapply sunscreen every two hours when outdoors and after swimming or heavy sweating.
- Wear long sleeves, long pants when practical, a wide-brimmed hat, and UV-protective sunglasses.
- Seek shade whenever possible.
- Avoid direct sun exposure between 10:00 AM and 4:00 PM, when UV rays are strongest.
- Never use tanning beds.
Frequently Asked Questions
Did I cause this melanoma?
No.
Melanoma develops because of a combination of genetic factors and accumulated UV damage over many years. It is not caused by one specific event or something you intentionally did.
Can melanoma be cured?
Yes.
Many melanomas are cured with surgery alone when they are detected and treated early.
Even for more advanced melanoma, modern treatments have improved outcomes significantly.
Should my family members be checked?
If you have a strong family history of melanoma or many atypical moles, your dermatologist may recommend that close family members have periodic skin examinations.
Can melanoma come back years later?
Yes.
Although the risk decreases over time, melanoma can occasionally recur many years after the original diagnosis. This is one reason why lifelong skin surveillance is recommended.
When Should I Contact My Family Doctor Immediately?
Contact your dermatologist promptly if you notice:
- A new mole that looks different from your other moles (“the ugly duckling”)
- A mole that changes in size, shape, or colour
- A mole that bleeds, crusts, or does not heal
- A rapidly growing dark spot
- A lump under the skin near the melanoma scar
- Persistent swelling of nearby lymph nodes
Do not wait until your next scheduled appointment if you notice concerning changes.
Key Take-Home Messages
- Melanoma is the most serious type of skin cancer because it can spread to other parts of the body if left untreated.
- Early detection and prompt surgery provide the best chance of a cure.
- Most patients with Stage 0 and Stage I melanoma are cured with surgery alone.
- A wide local excision is usually necessary even after the biopsy to ensure all melanoma cells have been removed.
- Some patients will also require a sentinel lymph node biopsy based on the thickness and features of the melanoma.
- Regular follow-up appointments, monthly self-skin examinations, and lifelong sun protection are essential to reduce the risk of recurrence and to detect any new skin cancers as early as possible.
A Final Reassurance
A diagnosis of melanoma is understandably upsetting, but it is important to remember that many melanomas are found at an early stage and are highly curable with appropriate treatment.
By proceeding with the recommended surgery, attending your follow-up appointments, and protecting your skin from future sun damage, you are taking the most important steps toward achieving the best possible outcome.
Disclaimer
This handout provides general educational information and is not a substitute for medical advice.
Your treatment plan, surgical margins, need for sentinel lymph node biopsy, follow-up schedule, and prognosis depend on your individual pathology report and overall clinical situation.
Always follow the recommendations of your dermatologist and surgeon.