Melanoma in Situ is also known as Stage 0 melanoma or very early stage melanoma. If I wasn’t getting annual skin cancer checks, the melanoma that was removed from my arm and my chest could have spread very quickly and been fatal.
Introduction
Melanoma in Situ is what I was diagnosed with in 2021. It scared the hell out of me to hear those words coming out of the doctor’s mouth. Thankfully, I had been getting annual skin checks and the location of the melanoma was on my arm – an easy place for an excision.
Melanoma in situ is where cancer cells affect the outer layer of the skin only – the epidermis. This means it has not spread to deeper layers of skin and you have an excellent chance of survival and full recovery.
In 2022, a second melanoma was discovered by my doctor – this time on my chest, and it was also removed. I was extremely lucky to catch this one so early too! So what exactly is Melanoma in Situ and what was my experience? Read on..
What is Melanoma in Situ?
Melanoma in situ is where melanoma cells are detected in the outer layer of the skin which is known as the epidermis. The cancer cells have not spread to deeper layers of skin or any further and it can be easily removed with an excision, involving the local area and surrounding skin as necessary. Early detection is key when it comes to melanoma because it is one of the most aggressive types of cancer and can spread very quickly, to lymph nodes and other organs, if undetected.
Those with fair skin and freckles (like me) are usually at higher risk of melanoma, but melanoma can affect anybody, even those with much darker pigment in their skin.
You can read about the clinical features of melanoma in situ HERE.
How long does Melanoma in Situ take to spread?
Melanoma can spread very quickly and it has been known to become life threatening in as little as 6 weeks if left untreated, and it can spread quickly to other parts of the body. It’s important to note that melanoma can appear on parts of the skin that are not normally exposed to the sun, and it can even appear internally, such as on the back of the eyeballs, and inside your intestines.
The best prevention is to regularly check your body for any moles or skin spots that may have changed colour, size or shape and get annual skin cancer checks by a professional.
How did I discover my Melanomas?
My first melanoma
I had a small dark mole on my left forearm which had been there for as long as I can remember. I only started having regular skin cancer checks in my 30s and I mentioned to the doctor that this particular mole seemed like it may have darkened. The Dr inspected it, decided it was safest to remove it and then do a biopsy on it, to which he discovered it was benign and therefore there was nothing to be concerned about.
I also had another, lighter-coloured mole which was about 2cm above the one that was removed which the Dr was not concerned about. Over the course of about 4 years, that mole, which was above the excision site, actually turned darker, grew in size, and it moved, that’s right, it moved, further down, so that it was eventually positioned exactly on top of the original excision site where the other one had been removed. It was definitely darker than in previous years but I didn’t think it was anything that looked concerning. After my doctor examined it closely, he thought it was best to remove it, and do a biopsy on this one too, considering it had changed – in colour, size and position. It turned out that this mole was in fact melanoma in situ, and so the doctor instructed me to have a second, wider local excision, to ensure that there was a clear margin and that no other cancer cells remained in my skin.
I had the second excision, all was clear and I was instructed to get skin cancer checks on my entire body every 3 months for at least the next 2 years, and then 6 monthly for the rest of my life.
My second melanoma
I also had a cluster of freckles with irregular borders, on my upper chest that started appearing over the course of a few recent years. Within 3 years it had increased in size and become slowly darker.
I had it checked several times by my skin cancer GP and by a dermatologist who both took photos and decided it should be monitored every 6-12 months.
The cluster of freckles was not raised in any way but it was changing. Between 2021- 2022 it became significantly larger and darker in colour.
My skin cancer doctor also noticed this change and was concerned enough to ask me to get it removed.
Obviously, this concerned me too and there was no way of knowing if it was melanoma or not until after they removed it and had a biopsy done on it. If it was in fact melanoma, they would need to cut a larger excision, and if not, I would be left with a big scar anyway.
I was indeed concerned about having a huge scar on my chest, especially if this cluster of freckles was going to be benign, but there was no way of knowing without cutting it out, so this was obviously the safest, most logical choice.
My skin cancer doctor (who has 30 years of experience with skin cancers) was correct.
After this cluster on my chest was removed and biopsied, it was diagnosed as melanoma in Situ (early stage one melanoma) and was once again, like the melanoma on my arm, caught early enough.
The procedure for a positive melanoma diagnosis is to then cut a wider excision to ensure a clean margin, making sure all cancer cells have in fact been removed.
So I booked in for another cut, and the doctors cut my chest another 2cm all around, with a result of clear margins, only healthy tissue present, and therefore no further surgery was necessary.
I am so thankful that my GP had the experience to flag both of my melanomas and that he was correct, meaning they were both caught early!!
I have been instructed to continue getting my skin checked every 3-6 months for the rest of my life.
My Dr also said I should be buying myself a lottery ticket as I’m so lucky both of these melanomas were caught so early!
I have communicated my experience to Andy so that he understands the risks of sun exposure. Without scaring him too much, I think it’s important to spread the message of sun safety in an age-appropriate way and so I always make sure he takes sun protection seriously and that he also spreads the message and his mum’s experience!
What was the process after diagnosis?
The appointment for the original excision on my arm was made pretty quickly, as doctors don’t like to muck around when it comes to potential melanoma, considering how quickly it has been known to spread. I had a needle in my arm to inject some local anesthetic, and the excision was made at the GP, and a few stitches were put in. After the diagnosis of melanoma in situ was made, the appointment for the second excision was also made pretty quickly, but this time, I had the excision done at the hospital in the skin cancer clinic. Same process; some local anaesthetic, a wide local excision, and some stitches. There was also the confirmation that came after that stated there was a clear margin and therefore no further excisions or treatment required.
For the melanoma on my chest, it was done under a general anaesthetic, as it was a much more sensitive area, and a larger cut to be made. I chose to get this done by a plastic surgeon, considering the area that was being cut, as I didn’t want to regret a decision to get it done by just any doctor within the skin cancer centre, who may potentially be less careful with the stitching, and therefore the scarring on my upper chest.
How often do I get skin cancer checks?
Currently, every 3 months, by a skin cancer doctor. If I am concerned about a particular skin spot, like the case with the one on my chest, my doctor refers me to a dermatologist for a second opinion, if he too is also unsure.
After 2 years in the clear, I will get checked every 6 months for the rest of my life, after recommendation from my doctors.
What’s involved in a skin cancer check?
For a full body skin check, I take all of my clothes off, except my underwear and my doctor checks my whole body with a special microscope-type light. I also make sure I don’t have any makeup on my face so he can check the skin on my face properly. He asks me if there are any spots or areas of concern under my underwear and if there are, I show him. He checks my scalp, behind my ears, between my toes, and all other areas of my skin. If he is concerned or unsure, he wipes the spot with an alcohol wipe, looks at it carefully under his light/magnifier and he also takes photos for monitoring. That way we can compare how that spot or lesion may change over time.
How did I save my friend’s life?
First of all, I talked about my experience and how I was shocked that such a small little mole turned out to be skin cancer. I encouraged all of my friends to get regular skin cancer checks, no matter their skin type. One of my friends who I was working with told me she had a mole on her chest that had changed a bit and darkened. She showed me and I thought it looked very suspicious as it was irregular in shape and very dark, almost black. She said it had been there since she was born but it had grown and darkened. I encouraged her to get it checked by a skin cancer doctor but she thought this was unnecessary. She was of middle eastern descent and therefore had quite olive skin. I told her that anyone can get skin cancer, not just fair skinned people like me and again, encouraged her to at least get it checked.
She showed her family and asked their opinion, and they too thought this was unnecessary.
While she was at work the next day, at the long day care centre where we worked together, I waited for her break time and being the pushy friend I am, I made a phone call to my skin cancer doctor, made an appointment for her and put her on the phone. She reluctantly made an appointment to “shut me up” and went along the next week.
The doctor was also concerned about this mole, went ahead and removed it, and it turned out it was also, like me, melanoma in situ.
My friend was in shock but also incredibly relieved to discover that it was Stage 0 melanoma and that it had been detected early.
Her family were very grateful to me and on this occasion, I feel pleased that I was able to share my experience and that my slight pushiness helped to save her life too.
FAQs about Melanoma:
How common is Melanoma?
Here are some statistics for you, from the Melanoma Institute Australia:
- Every 30 minutes, someone in Australia is diagnosed with Melanoma
- Australia has the highest melanoma rates in the world
- Melanoma is the 3rd most common cancer in Australia
- 95% of melanomas are caused by overexposure to the sun
- If caught early enough, 90% of melanomas can be cured by removal, or by surgery
- Melanoma is the most common cancer for Australians aged between 20-39
- 2 in 3 Australians will be diagnosed with some kind of skin cancer by the age of 70.
How serious is melanoma in situ?
When melanoma is diagnosed as melanoma in situ, that in itself is not dangerous or life-threatening at all, but if left untreated or given the opportunity to metastasize and spread into deeper layers of skin, it can spread quickly and become life-threatening in a short amount of time. It is therefore vital to get regular skin checks and make sure that any diagnosis of melanoma in situ is treated and removed, to prevent further spread.
How quickly should melanoma in situ be removed?
After a diagnosis of melanoma in situ, it is important that it is treated/removed as quickly as possible – ideally within days.
What is the survival rate for melanoma in situ?
Melanoma in situ, or Stage 0 melanoma is highly curable with a survival rate of above 98%. This is due to the cancer cells being in the epidermis only, and therefore surgical removal is easy when detected early.
What causes melanoma in situ?
The Australian Skin Cancer Foundation states that most skin cancers (95%+) are caused by too much sun exposure (UV rays) and that you can lower your risk of getting skin cancer by protecting your skin from the sun and from other forms of UV such as tanning beds.
The Australian Skin Cancer Foundation has heaps of helpful info on skin cancers, sun safety, melanoma statistics etc.
Conclusion
If a doctor can detect melanoma early enough, the survival rate for that patient is excellent. Melanoma is an invasive cancer and spreads quickly if left undetected and untreated. I check my own skin regularly now, in the shower and I get checked by my doctor every few months.
Cancer research has come such a long way and the number of people being diagnosed with melanoma, as well as those dying from melanoma has significantly reduced in the past 20 years.
Personally, I have fair skin with freckles as well as moles, so I have very vulnerable skin and I had intense sun exposure in my teen years and in my 20s. I am therefore at increased risk of melanoma due to my skin type and my history, but it’s so important to remember that melanoma can affect any skin type.
If a doctor can diagnose melanoma early enough, while it is still in the upper layer of skin, the treatment options are excellent, and it doesn’t have to turn into an invasive melanoma.
Early detection, early diagnosis and regular skin cancer checks really are the key!
And continue to spread the sun safety messages to your kids when they’re playing outside, so that the number of melanoma diagnoses continues to decrease for future generations. Hopefully the sun-safe messages really are trickling down to our children so that they can understand the risks and continue to protect themselves.
Do you get skin cancer checks? Why/why not?? Let me know in the comments!
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