What to Expect
Skin cancer can usually be treated successfully if caught early. The five-year survival rates for patients whose melanoma has not spread (“in situ” or “localized”) is expected to be 98 percent. Most melanomas (83 percent) are diagnosed at this localized stage. For those whose cancer has spread to nearby (“regional”) lymph nodes, the five-year survival rate is 60 percent, and if it has spread to distant parts of the body, 14 percent.
Note: a five-year survival rate means a diagnosed patient is disease-free, in remission, or in treatment five years after their initial diagnosis.
Hearing the words
Nobody wants to the word cancer. You may have feelings of fear, confusion, and uncertainty. Understanding your diagnosis can be a first step in handling these feelings and living with your cancer and your treatment. We encourage you and your family to ask questions about your diagnosis and take an active role in making decisions about your treatment and follow-up care.
Most likely, if you are being seen at Seattle Cancer Care Alliance, you have already been diagnosed with cancer. Your referring doctor based his or her diagnosis on a number of initial screenings, examinations, and diagnostic tests, which may have included the following:
This appointment includes a series of questions about your age, family history, personal cancer experiences, sun exposure, and other risk factors. Your doctor will ask about your symptoms, when the skin lesion first appeared, and if it has changed in size or appearance. Your doctor will do a complete examination and check the lesion in question, any other suspicious moles or marks, and for enlarged lymph nodes near the lesion.
- Medical and family history and physical exam.
This appointment includes a series of questions about your age, family history, personal cancer experiences, sun exposure, and other risk factors. Your doctor will ask about your symptoms, when the skin lesion first appeared, and if it has changed in size or appearance. Your doctor will do a complete examination and check the lesion in question, any other suspicious moles or marks, and for enlarged lymph nodes near the lesion. - Biopsy
Certain biopsies provide information about a suspected or known skin cancer. A biopsy involves taking a tissue sample of the suspicious area and sending it to the lab. Next, a pathologist—a specialist who identifies diseases by studying cells and tissues under a microscope—examines your sample. The size and location of the problem helps determine the type of cancer you may have. All biopsies will leave a scar, so discuss your concerns with your doctor beforehand.Common types of biopsies include:
- Shave biopsy
A sterile razor blade is used to “shave-off” the abnormal-looking growth. - Punch biopsy
A special instrument called a punch or trephine is used to remove a circle of tissue from the abnormal-looking growth. - Excisional biopsy
A scalpel is used to remove the entire growth.
- Shave biopsy
Second opinions
Melanoma can be hard to diagnose, so it is reasonable to want to get a second opinion.
Your diagnostic work-up at SCCA
To fully understand your cancer and discuss the most advisable treatments with you, your skin cancer team will review your referring doctor’s findings and order one or more of the following tests:
- Wide local excision
This is a surgical procedure to remove some of the normal tissue surrounding the area where melanoma was found, in order to check for cancer cells. - Lymph node mapping and sentinel lymph node biopsy
This is a procedure in which a radioactive substance and a blue dye are injected near the tumor. The substance flows through lymph ducts to the sentinal node or nodes (the first lymph node or nodes where cancer cells are likely to spread). The surgeon removes only the nodes where the substance appears. A pathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes. - Computerized tomography
Usually called a CT scan (or “CAT scan”) or computerized axial tomography, this procedure makes a series of detailed pictures of areas inside your body from different angles. A computer linked to an X-ray machine makes the pictures. An iodine-based dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. Pictures may be taken of the chest, abdomen, and pelvis to see if the melanoma has spread. - Chest X-ray
A chest X-ray is an X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can go through your body and onto film, making a picture of certain areas inside your body. - Position emission tomography (PET)
A PET scan uses glucose (a form of sugar) containing a radioactive atom. A small amount is injected into your arm. While lying in a PET machine, a special camera detects the radioactivity in any part of your body. Cancer cells generally absorb large amounts of the radioactive sugar and look brighter, so the doctor reading the PET scan can identify them. - Magnetic resonance imaging (MRI)
MRI scans use radio waves and strong magnets instead of X-rays. Energy from the radio waves is absorbed by your body and then released in a pattern formed by the type of tissue and by certain diseases, such as melanoma. A computer translates this pattern into a very detailed image of designated parts of your body. - Bone scan
A bone scan looks for abnormalities in your bones. It can focus on a particular joint or bone, but in cancer diagnosis it is more typical to scan the whole body. A small amount of a radioactive substance called a radionuclide is injected into your blood stream. Aside from the injection, the procedure is painless. The scan uses a gamma camera that picks up radioactivity where it collects in your bones, identifying “hot spots” which can indicate bone cancer or other conditions like arthritis. - Laboratory tests
Your doctor may order some medical procedures to test samples of your tissue, blood, urine, or other substances in your body. These tests help diagnose diseases, plan and monitor your treatment, and follow your disease over time.
The next step
Once your tests are completed, your team will have an educated view of your illness and its stage, including whether or not it has spread, and where it has spread. At this point you can begin to consider and discuss treatment options with your SCCA team of specialists.
Ask someone you trust to go with you to doctors' appointments and tests. This person can provide emotional support, help by taking notes at visits, and do research on your disease and treatment options. Keep all your information, ideas, and questions organized, perhaps in a notebook.
Keep a list of questions and concerns to discuss with your team.
Tips for talking with your doctors
Good communication is the centerpiece of your cancer care. And you can help make it work. One way is to be prepared for appointments with your providers. Here are some ideas to make the most of your visits:
- Bring a written list of your concerns and questions. Your doctor may not have time to talk about everything on your list, so prioritize items, putting the most important at the top.
- Read your list to your doctor and write down her or his answers. Some people bring a tape recorder so they can listen to the conversation at home when they are more relaxed and can take in more information.
- Consider bringing a trusted friend or relative to take notes for you to read later.
- Tell your doctor and nurse how you are feeling about things. Your SCCA skin cancer team is a group of sympathetic listeners who care about their patients. If your doctor cannot deal with an issue directly, she or he knows who can.
- Before you leave your doctor’s office or a treatment appointment, make sure you totally understand all the next steps. At SCCA we work hard to be very clear with our patients. If you don’t understand something, please ask.
Take care of yourself
Give yourself extra care during this time—physically and emotionally. Exercise and a healthy diet are especially important now. Taking care of yourself and getting the support you need may make a huge difference in how you experience your treatment and your quality of life during treatment. You may want to join a support group, or talk to a nutritionist, social worker, or chaplain.
A note for families and close friends We recognize that when a family member or close friend has cancer, you too are deeply affected. You probably will experience times of fear, frustration, sadness, and hope. The staff is here to help you as well and to encourage you to take good care of yourself. Taking care of yourself provides you with the ability to take care of the one you love. You may find useful information on the Practical & Emotional Support.
If you have been diagnosed with melanoma and referred to the SCCA Melanoma Clinic, your first stop will most likely be at the Seattle Cancer Care Alliance outpatient building on south Lake Union. Your team of melanoma specialists will review your information, do any additional tests, and discuss your diagnosis and treatment options with you.
If you have not been diagnosed with skin cancer, but are concerned about your moles, you may want to make an appointment at the Dermatology and Dermatologic Surgery Center at UW Medical Center for an evaluation of your pigmented lesion, especially if you are at risk for melanoma.
Pigmented lesions include a variety of skin abnormalities, the most common being moles. Early diagnosis of melanoma is possible with dermoscopy and biopsy. People at high risk for melanoma can also benefit from the clinic’s professional, confidential grid photography service, which allows doctors to assess changes in moles over time. People who are diagnosed with melanoma at the clinic are then referred on for dermatologic surgery or to medical or surgical oncology at SCCA.
Your cancer care team at the Seattle Cancer Care Alliance offers comprehensive follow-up care once you complete your treatment. Our patients say that they find it reassuring to see the same specialists who treated them, all experts in skin cancer, for their follow-up visits.
If you were treated here at SCCA but do not live in the Seattle area, you may choose to receive your follow-up care with your local doctor. In that case, we usually ask patients to keep us up-to-date on their health status by phone or mail and have their test results sent to SCCA.
Once treatment is over, here are some suggestions for staying healthy:
- Keep up your self-checks
Continue (or start) doing a monthly head-to-toe body check. Go to Screening and Detection for instructions on doing a self check. - Stay in touch
Any new or ongoing symptoms, or any worrisome growths, bumps or spots should be reported to your medical oncologist or nurse practitioner right away. Use the guidelines in the Signs and Symptoms section to help you identify any trouble spots. - Protect yourself
Protection from sun exposure should remain a top priority. See the Prevention section for information on how to do this successfully. - Show up
Keep all of your follow-up appointments. These will allow your doctor to catch any new skin cancers early, and can also give you peace of mind. - The skin cancer follow-up schedule Your follow-up visits are very important. Your doctor will tailor your follow-up schedule to your individual needs, but here is a typical schedule:
- Melanoma
Melanoma can recur after it has been treated. It may return to the original site or turn up in other parts of the body, such as the liver or lungs. - Basal cell cancer
Patients with basal cell cancer are likely to have a new or recurrent tumor within five years of the first one, so you will be seen for a thorough exam every six months for five years, and once a year after that. - Squamous cell cancer This kind of cancer can spread more easily than basal cell. For this reason, you will have a skin exam every three months for several years after treatment and then every six months after that.
As part of the Survivorship Program at SCCA, a clinic has been developed for general medical oncology survivors treated with conventional therapy. This clinic is the Medical Oncology Survivorship Team (MOST). For more information about the MOST program, click here.
Worrying about those visits?
Many people find that they experience a lot of fear and anxiety around the time they have a follow-up appointment. The question often lingers in the back of every cancer patient's mind: What if my cancer has come back? This is a common worry, and the staff at SCCA can help you cope with these strong emotions and refer you to other resources that can also help.