You have been referred by your GP to the dermatologist at U-clinic because you may have a melanoma. In this folder you can read what to expect per visit to our clinic. This trajectory is fixed and is also called Zorgpad Melanoma . This way you know what to expect before, during and after the treatment.
For general information about melanomas, please refer to the melanoma folder .
Your GP has referred you for a suspicious mole (suspected melanoma). The dermatologist is now your primary care provider for this mole.
During the first consultation, the dermatologist looks at the birthmark with the naked eye and with a special magnifying glass (dermatoscope). If the mole looks suspicious, an appointment for removal is scheduled (medical term ‘excision’). At some consultation hours, the suspected mole is immediately removed.
Removing the melanoma: first surgery
Removing a mole is called excision. The mole is removed under local anaesthetic. The wound is sutured. The mole is placed in a jar and then sent to the pathologist. The pathologist looks at the mole under the microscope and assesses whether the mole is cancerous. In general, the results are known within two weeks.
Sometimes the pathologist has doubts about the diagnosis and the mole is first assessed by other pathologists or discussed in a working group (melanoma panel). In that case, it sometimes takes longer than two weeks for the results to be available.
The results after the first operation
- After 7-14 days, you will return to the dermatology outpatient clinic for the sutures to be removed. How long this takes depends on where the suspected mole was removed. In general, the results of the pathologist will be in.
- The dermatologist will discuss the results with you.
- If the mole is benign, the treatment is concluded.
- If there is a melanoma, additional surgical treatment follows.
Second surgery (re-excision)
The pathologist decides whether a mole is malignant or not. He also looks at how thick the melanoma is. This is called Breslow thickness. It is also checked whether there are dividing cells (mitoses) and whether ulceration (ulceration) is present. Based on these properties, it is then determined what needs to be done.
In principle, a second excision always follows. This is to prevent metastases. The second excision is deeper; all the subcutaneous fat at the location of the scar is included. This procedure is usually performed under local anaesthetic. In general, the second excision can also be performed on an outpatient basis by the dermatologist. In some cases, and especially if the melanoma is somewhat thicker, it is advised to do a lymph node examination. This is called sentinel node examination (sentinel node procedure).
During the consultation, the dermatologist will discuss whether a sentinel lymph node examination makes sense for you. In that case, the re-excision is performed by the surgeon under anesthesia and the sentinel node examination is also performed during this operation.
This surgery is scheduled within six weeks of the diagnosis of melanoma. If the sentinel node procedure would be a logical next step in your case and you agree with it, you will be referred to the Antonie van Leeuwenhoek hospital for further treatment.
The result after the possible second operation
- After 7-14 days you will return to the person who performed the procedure for a wound check and the results. If there are no indications of metastasis, three months after the diagnosis of melanoma, an appointment will be made with the dermatologist for a check-up.
- If metastases have been found, further treatment will take place in the Antonie van Leeuwenhoek hospital if this had not already happened.
How often and for how long you are monitored depends on the thickness of the melanoma.
- Melanomas that are thin (Breslow smaller than 1 mm) and have no ulceration and/or dividing cells only require a check-up appointment. The dermatologist will then check you again.
- For melanomas that are thicker (Breslow larger than 1 mm or the presence of dividing cells or ulceration), you will be monitored for five years. The checks are more frequent in the beginning (possibly four times a year) and later less often (up to once a year). During the check-ups (depending on the stage) it is usually not necessary to take X-rays, ultrasounds or scans.
- If you are concerned about new spots or other urgent matters, you can always contact the dermatologists.
The outlook for a melanoma is highly dependent on the risk of metastasis developing. Since most patients are treated at an early stage of the disease, the outlook is generally favorable. Here, the thinner the melanoma, the greater the chance of a complete cure. This percentage is lower for melanomas with a greater Breslow thickness. Discovery and removal of a melanoma is very important. If the melanoma is removed, in a large proportion of people the disease never returns. In a number of people, the melanoma does return and can spread (metastasize).
To view your own outlook you can use http://melanomaprognosis.org/
Contact with people who have also been treated for a melanoma (fellow patients) and further information can also be obtained from the patient organization for people with a melanoma: www.stichtingmelanoom.nl
Do you have questions?
If you have any questions, don’t hesitate and ask your treating dermatologist. On working days you can contact U-clinic Westerpark on telephone number 085 – 022 0580.
1187 KL Amstelveen
1051 KN Amsterdam