After Diagnosis

HAVE YOU BEEN TOLD YOU HAVE SKIN CANCER?

 

Receiving a cancer diagnosis is never easy.  Arming yourself with information may help you feel more in control of the situation.  Save Your Skin Foundation wishes to bring hope and support to all those newly diagnosed, currently undergoing treatment, or to those in remission. We invite all melanoma patients, at any stage, to get in touch.

 

Hand in hand, we fight melanoma together.

FINDING A DOCTOR

 

The Doctor who gave you your diagnosis may not be the right person to treat you. Ask about their experience with the skin cancer you are diagnosed with; if they are not experienced, ask for referrals to other doctors in your area with more expertise.

 

You should ensure the Doctor who will help you through your journey with skin cancer is both experienced with your specific diagnosis and understands you.

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?

Melanoma Staging

 

Staging is commonly used in melanoma diagnosis and treatment to indicate the advancement and severity and cancer in a patient. Melanoma stages range between 0-IV based on the TNM (tumour, nodes, metastasis) system. The TNM system is dictated by the size of the primary (first) tumour, the occurrence of cancer cells in the surrounding lymph nodes, whether the cancer has metastasized (spread to other regions in the body), and whether there is ulceration (if there is ulceration, the skin covering the melanoma cannot clearly be seen). While these figures can be intimidating in the later stages, the staging system is imperative for dictating the treatment process a patient will undergo.

Stage 0 (in situ)

Your doctor will perform a full-body skin examination at least every year. You should examine your skin every month.

Stage IA

Your Dermatologist will see you on the following schedule to create a history and perform a physical examination:

  • Every three to twelve months for five years
  • Once a year after that

Also, at least every year, your doctor will perform a full-body skin examination. You should examine your skin and lymph nodes every month.

Stage IB, IIA, IIB, IIC

Your Dermatologist will see you on the following schedule to take a history and perform a physical examination:

  • Every three to six months for two years
  • Every three to twelve months for two years
  • Once a year after that

Your doctor may decide to perform selected investigations, such as blood tests or imaging studies every six to twelve months, to screen for tumour recurrence or spread.

Also, at least every year, your doctor will perform a full-body skin examination. You should examine your skin and lymph nodes every month.

Stage IIIA, IIIB, IIIC, IV

Treatment of stage III melanoma and beyond will be performed by an Oncologist.

 

Physical examination (skin examinations, chest x-rays, CT scans of trunk, pelvis, and head)

  • Year 1: every three months
  • Year 2 : every four months
  • Years 3-5: at least every six months
  • Annually after five years

TREATMENT OPTIONS

 

There are several treatments for skin cancer. Your melanoma diagnosis, age, location, and general health are some of the factors that should be taken into account when you are considering your options.

 

Treatments exist in the following broad categories that could be tailored to fit your needs:

Immunotherapy

This is a new drug treatment area in which the immune system is enhanced so the body can fight off cancer in the way it fights more common ailments.

Combination Therapy

The combination of two or more therapies.

Surgery

In certain cases it is possible to operate and physically remove the cancer tumours. This is not always an option.

Chemotherapy

These drugs are used to treat many types of cancers by impacting the cancer cells’ ability to grow or multiply. Due to their impact on non-cancer cells, these treatments can have side effects.

Radiation Therapy

Destruction of tumours using a high-energy radiation beam.

Targeted Therapy

A treatment that interferes with specific molecules involved in the growth and spreading of cancers, inhibiting the development the cancer.

BRAF MUTATION AND INHIBITOR TREATMENTS

 

BRAF is a human gene that produces the protein b-raf, which is involved in cell growth and division. It has been discovered that, occasionally, these genes are mutated in cancers; this mutation, called the BRAF V600, allows opportunities for cancers to be treated with a BRAF inhibitor. 

 

Approximately half of melanoma skin cancers have a mutation in the BRAF gene, and some of the BRAF-inhibitor (or targeted chemotherapy) single-agent drugs currently used to treat BRAF-positive melanoma include vemurafenib (Zelboraf), combimetinib (Cotellic), dabrafenib (Tafinlar), and trametinib (Mekinist), and trametinib and dabrafenib are also available as a combination therapy. 

 

A more up-to-date list of available treatments can be found on the Canadian Agency for Drugs and Technologies in Health (CADTH) website’s Provincial drug formulary database, which can be accessed hereFor more information about BRAF inhibitor therapies and whether they might be an option for you, ask your Doctor.

FOLLOW-UP AND MONITORING

 

Follow-up after melanoma treatment depends on the stage of the melanoma. A melanoma diagnosis increases the risk of another melanoma. Therefore, your doctor will perform a full-body skin examination, at least every year, for the rest of your life.

 

Self-monitoring:

 

Your doctor will also teach you how to examine your skin and lymph nodes. You should examine your skin at least monthly. Make sure you check the back of your body. Use a mirror or have someone check for you. Look for changes in moles, any new growths, sores that do not heal, and abnormal areas of skin.

 

Contact your doctor right away if you notice any abnormalities. Your doctor may also recommend that you examine your lymph nodes every month. A schedule like the following one is followed if you have no signs or symptoms of melanoma.

If you do develop new signs or symptoms, your doctor will investigate them and determine appropriate treatment and follow-up based on your test results.

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.

 

Some of your questions about clinical trials may be answered by PRE-ACT (Preparatory Education About Clinical Trials), a resource created by the American Society of Clinical Oncology. While PRE-ACT does provide a comprehensive guide to the clinical trial system, be aware that these videos were created for an American audience, and some of the information in them may not be applicable to Canadian patients.

 

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.

 

For more information about Clinical Trials in Canada, please click here to see our page Additional Resources and Support Groups

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Making awareness and education available is crucial. Since 2006, the Foundation has worked to raise awareness of melanoma and non-melanoma skin cancers focusing on education, prevention and the need for improved patient care.

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