Care pathway for melanoma

A mole should be suspected of being a melanoma if it has the following features: 

• asymmetrical shape 
• uneven, meandering edges 
• uneven color with different shades 
• more than 6 mm in diameter 
• increasing size and changing appearance 
• occasional tingling and itching. 

Due to its visibility, melanoma is usually possible to detect at an early stage. In this case, the prognosis is very good.

Diagnosis and treatment may be delayed if the appearance of the melanoma is atypical: it may resemble an ordinary wart or it may lack dark pigmentation. 

Abnormal-looking and growing moles can be inspected with a dermatoscope. A dermatoscope is a handheld device that allows to see deeper beneath the surface layer of the skin.

Suspicious skin changes can be surgically removed and sent to a pathologist for a more detailed microscopic examination. Asymptomatic, small pigmented moles do not need to be removed just in case. 

If melanoma is detected in a skin lesion removed from your skin, your physician will refer you to HUS for further examinations and treatment. 

A physician experienced in treating melanoma will process your referral and, depending on the thickness of the melanoma, refer you either directly to repeat surgery or have your situation discussed in a multi-professional treatment meeting for skin tumors.

In a multi-professional treatment meeting, a surgeon, dermatologist, oncologist and pathologist will give a recommendation on appropriate follow-up treatment. Based on this, you will be invited to see either a surgeon, dermatologist, or oncologist.

In repeat surgery, we will remove the surgical scar and a required area around it. We operate on thin melanomas with a good prognosis at HUS Dermatology, and other melanomas are operated at the Plastic Surgery Unit. In connection with repeat surgery, if necessary, we will examine the possible spread of the cancer to the lymph nodes with a sentinel lymph node mapping.

We will plan the necessary additional examinations only after the repeat surgery, when the pathologist will inform us of the thickness of the melanoma and other factors predicting the severity of the disease. If the melanoma is localized and superficial and no cancer is detected in the sentinel lymph nodes, follow-up alone is sufficient. 

If the tumor is thick and extends deeper into the skin, we determine the extent of the cancer with an ultrasound examination of the lymph nodes prior to the surgery. 

If your follow-up is directed to HUS Comprehensive Cancer Center due to risk factors, you will undergo a full-body computed tomography after the surgery.

At the appointment, the physician will go through the surgery plan with you and after surgery, the physician will share the findings observed during the procedure. Your physician and the nurses will inform you about upcoming examinations and the progress of your treatment. 

Local melanoma, i.e. cancer limited to the skin, can usually be treated curatively. The main treatment for skin melanoma is surgery. If the risk of melanoma recurrence is high, you will receive adjuvant therapy to complement the surgery. Treatment typically lasts for a year.

After surgery, follow-up usually continues for five years at HUS or primary health care. The risk of recurrence of thin melanomas is low, and surgery enables more than 90 percent of patients to be cured. 

Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the cancer treatments. We help treat difficult symptoms and offer conversational support. 

A decision on palliative, i.e. symptomatic, treatment is made when the focus of your treatment shifts from slowing down the progression of cancer to managing the symptoms. In this case, treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the palliative care unit or to the palliative outpatient clinic or hospital-at-home unit in your area.

Melanoma patients are recommended to have regular follow-ups in primary health care after the follow-up at HUS has ended. People who have had melanoma once are at risk of developing melanoma again.