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Newly Diagnosed

Are you newly diagnosed with skin cancer?

Getting a diagnosis of any type of cancer is not easy for anyone. It’s important, however, to take charge of the situation by arming yourself with information. If you’ve just been diagnosed with skin cancer, being at this website and this page is a good start!

Finding a Doctor

The doctor who gave you your diagnosis may not be the right person to treat you. Ask him or her about their experience with the type of skin cancer you have. If they are not experienced, ask for referrals to other doctors in your area with more experience. You are not insulting the doctor by doing this, you are making sure you get the best possible care and treatment. You need to ensure the doctor who will help you through your journey with skin cancer is both experienced and relates well to you. Being comfortable with your doctor is an important first step, though in parts of Canada outside major centres your options may be limited.

Questions to Ask your Doctor

It is important to ask your doctor any questions you might have. Some questions might be difficult for you to ask – and for your doctor to answer – but ask them anyway. Write questions down when you think of them so you have a list at the time of your appointment.

When you are being given answers by your doctor, make written notes and ask for answers to be repeated or explained if there’s something you miss or don’t understand. It’s always useful to have a friend or family member with you at an appointment to take notes, to help remember things and give you someone to discuss the appointment with afterwards.

Some of the things you will likely want to ask about are:

  • What stage of melanoma do I have?
  • What are the available treatments for this stage of melanoma?
  • Will I have more than one treatment?
  • What are the risks and benefits of each treatment for melanoma?
  • Will my age, general health, stage of melanoma, and other health conditions limit my treatment choices?
  • Do I have to get treated?
  • Where will I be treated? Will I have to stay in the hospital or can I go home after each treatment?
  • What can I do to prepare for treatment? Should I stop taking my medications?
  • How soon should I start treatment? How long does treatment take?
  • How much will the treatment cost? How can I find out how much my insurance company will cover?
  • How likely is it that I’ll be cancer-free after treatment?
  • What symptoms should I look out for while being treated for melanoma?
  • When will I be able to return to my normal activities?
  • What is the chance that the melanoma will come back or spread?
  • What should I do after I finish treatment?
  • Are there supportive services that I can get involved in? Support groups?

Treatment Options

There are a number of different types of treatment options for skin cancer, including some that may be new, but quite promising. Various factors should be taken into account to decide what treatment option might be best for you at a particular time.

Treatments are in the following broad categories, with different possibilities in each one that would be tailored to your particular cancer and other factors:

Immunotherapy
This is a new treatment area in which drugs enhance your own body’s immune system so it will fight off the cancer similar to the way your body fights other more routine infections.
Chemotherapy
These are drugs that are used to treat many types of cancers by impacting the cancer cells’ ability to grow or multiply. Due to their impact on the non-cancer cell in your body, these treatments can have side effects.

Combination Therapy
As the name implies, this involves a combination of two or more different types of therapy.
Radiation Therapy
This therapy uses a high-energy beam of radiation aimed at your tumours to kill them.

Surgery
In certain cases it is possible to operate and physically remove the cancer tumours. This is not always an option.
Targeted Therapy
A treatment that interferes with specific molecules involved in the growth and spreading of cancers, inhibiting the development the cancer.

Understanding your Pathology Report

A pathologist is a doctor who evaluates cells and tissues to diagnose disease. The pathologist examines the biopsy sample under the microscope to diagnose melanoma. In the pathology laboratory, the biopsy specimen is prepared for examination. The sample is embedded in wax, sliced very thinly, and stained with dyes. The stain helps the doctor see the cells clearly. Preparing the sample in the laboratory usually takes one to two weeks. Sometimes a dermatopathologist, a doctor who specializes in diagnosis of diseases of the skin, also examines the biopsy sample. This may take extra time.

The report also contains other information that may include the terms below. If there is anything you do not understand, ask your doctor.

  • How thick the melanoma is (Breslow index)
  • Presence of any skin ulceration (ulceration status)
  • How deep the melanoma has grown (Clark level). The larger the level number the deeper into the tissue it extends. Depending upon where the melanoma is located on the body, the millimeters of depth for each Clark level can vary widely, so one person’s Clark’s III may be 1 mm, while another person’s is 2 mm.
    • Clark’s Level I—lesion involves the dermis
    • Clark’s Level II—lesion involves the papillary dermis
    • Clark’s Level III—lesion invades and fills the papillary dermis
    • Clark’s Level IV—lesion invades reticular dermis
    • Clark’s Level V—lesion invades sub-cutaneous tissue
  • How fast the melanoma cells are growing and dividing (mitotic rate)
  • Presence or absence of melanoma cells in the normal tissue around the lesion (peripheral margin status)
  • Presence or absence of melanoma cells in the normal tissue under the lesion (deep margin status)
  • Presence of tiny tumours near the primary melanoma (microsatellitosis)
  • Location of the melanoma (tumour location)
  • Size of the melanoma (tumour size)
  • Decrease in tumour size (tumour regression)
  • Presence of white blood cells in the melanoma (tumour-infiltrating lymphocytes)
  • Growth of the melanoma down into the skin (vertical growth phase)
  • Growth of melanoma around nerves (perineural invasion)
  • Melanoma type based on features of the cells present (histologic subtype)
  • Presence or absence of dense connective tissue (pure desmoplasia)

(“Understanding your Pathology Report”. Melanoma Network of Canada.)

It is very important for you to understand what the pathology report says about your melanoma. Pathology results help determine treatment options.

Upon diagnosis and after you have had a chance to review this new information, it is important to become an active participant in your treatment. Begin by bringing a family member or friend to your appointments who can take notes, so that you may concentrate on listening to your doctor.

More information about melanoma staging can be found here.

Clinical Trials

New treatments are tested in clinical trials before they are approved for general use. There are safeguards in place to ensure clinical trials are as safe as possible and meet medical ethical standards. Participating in a trial can be a way to have access to potentially helpful new therapies you couldn’t get any other way.

Clinical trials are funded by pharmaceuticals evaluating their new treatments. Therefore, the treatments, tests, and doctor visits are usually paid for and patients are followed very carefully.

Clinical trials usually have very specific criteria for the patients who can participate, such as severity or stage of disease and whether and what types of previous treatments you have had.

If you are found to be eligible, most studies will not allow you to choose whether you will be put into the group of patients given the existing standard treatment or the group receiving the new medicine. Often, neither you nor your doctor will be told which treatment you are receiving.

This randomization of what you are assigned to, and blinding of you and your doctor to the treatment you are getting, is an important part of ensuring clinical trials are as free from bias as possible and therefore, ensures the results are as clear as possible.

If you are interested in participating in a clinical trial, ask your doctor if there are any appropriate studies available to you.

Finding clinical trials

You can find out about trials for melanoma or other skin cancers from the following website: www.ClinicalTrials.gov.

It’s operated by the United States National Institutes of Health which keeps track of studies being conducted for all types of diseases around the world. Search for trials for your specific cancer and location to see what studies might be open to you, then discuss them with your doctor.

Health Canada operates a similar database for Canadian studies, accessible here.