How Melanoma Spreads

Once you have been diagnosed with melanoma, if it is still in Stage 1 or 2, it is likely localized (i.e. the tumor or tumors are in one small area) and it has not spread to other parts of your body. In this case, surgery to remove the melanoma and the surrounding tissue is usually all that is need to prevent spreading. However, if you have been diagnosed with Stage 3 or 4 than the melanoma has already begun to spread.

Melanoma spreads in two different ways: either through the lymphatic system (more commonly) or through the blood system (less common, usually only at the Stage 4). The lymphatic system is a series of vessels in your body, much like your blood vessels, except your lymphatic system is used by your body’s immune system to transport disease-fighting white blood cells. The lymphatic fluid flows throughout your body through the lymph vessels. You also have lymph nodes, which are center points in the lymphatic flow – similar to an intersection, many lymphatic channels flow into and out of a lymph node. Here are some of the ways melanoma can begin to spread:

Tumor gets too large

Unfortunately, if the melanoma tumor gets large enough, it can pass down from the surface area of the skin, and touch or penetrate the lymphatic channels. At that point, some of it can break off and start travelling through your lymphatic system. This is the primary way melanoma spreads. Unfortunately, it’s very hard to tell whether melanoma has begun to spread until a tumor is detected, and melanoma can be spreading for a while before a tumor is detected. However, the treatment protocol for melanoma will change depending on whether it has spread. Hence, if a doctor suspects the melanoma it big enough that it could have started to spread, they may do a procedure called a lymph node dissection. This is done to test whether any of the closest lymph nodes to the origin site of the melanoma have melanoma cells in them. If there are melanoma cells in the lymph nodes, it means the melanoma has begun to spread. If there are no melanoma cells in the lymph nodes, it is unlikely, but still possible, that the melanoma has begun to spread.

In short, the easiest way to prevent a melanoma from spreading is to detect it early, and have it removed surgically by a doctor who has a lot of experience with melanomas. If the melanoma is removed before it gets big enough to penetrate into the lymphatic system, there is almost no chance it will ever develop into a more serious case of melanoma. You want to make sure this procedure is done by an experienced doctor because they need to make sure they take out enough of the surrounding tissue so they have a wide enough margin. This is because melanoma tumors sometimes grow in odd shapes, and there can be tiny tumors surrounding the main tumor. The good news is that the width of the margin that your doctor will need to take is well studied and documented, and as long as they follow the proper protocol on an early stage melanoma, they should be able to remove all of the tumor.

In addition to making sure you work with a doctor experienced with melanoma, it’s also important to trust your own instincts. If your doctor says that a suspicious mole or growth is not melanoma, but you’re not convinced that’s true, it is ok to go an get a second opinion from another doctor.

Other Theories

There are a number of other theories about what makes melanoma more likely to spread. There is often literature and opinion both supporting and refuting these theories, however, because they may be valid, they are presented here.

Needle Biopsies^(1)(2)(3)

Some evidence exists that needle biopsies, which are used as a non-invasive manner of extracting cells to test for cancer, can actually help to spread the cancer itself. The basic theory is that when you insert a needle into the tumor and then extract it, you can leave a trail of cancer cells along the needle path on the way out. In addition, some people believe the needle or the puncture from the needle, can release cancer cells into your blood stream or your lymphatic fluid. Studies that have attempted to quantify this risk in some cancers have found that the risk % is less that 3%. In any case, however, if you do decide to have a needle biopsy and the results confirm that you have cancer, it is best to start treatment immediately afterwards to minimize this risk.

Steroids⁽⁴⁾

Sometimes subcutaneous (i.e. “under the skin”) melanoma that appears as a lump, if not properly diagnosed, can be mistaken for a cyst. The danger, however, is that some doctors will treat a persistent cyst with a local steroid injection (with, for example, prednisone). While a cyst may respond positively to this treatment, injecting a steroid, like prednisone, could play some role in increase the spread. Some cases have also been documented that oral use of prednisone can cause melanoma to spread. One possible explanation for this is that the prednisone is an immunosuppressant (it reduces your immune system, which is why they are often used in treating auto-immune diseases). Melanoma is one of the few cancers that is treatable by stimulating the immune system, and hence, the immune system plays a role in suppressing melanoma. However, if you take an immunosuppressant like prednisone, it could lower your melanoma fighting ability. It is unclear, however, whether there are any studies that show a link between prednisone and melanoma.

Iron

There is some evidence that increased levels of iron can cause cancers to spread. Some theories suggest this is because increased iron levels help cancer tumors grow. One of the unique characteristics of a cancer tumor, is that as it grows, it sets up its own vascular system. In other words, it needs blood to survive, just like any of your body’s other tissues, and hence it needs to create its own blood vessels as it grows. However, in order to create blood vessels, your body needs sufficient amounts of iron. Hence, high iron levels can support a cancer tumors’ ability to grow by supporting its ability to build its own blood vessels. In fact, many new treatments called anti-angioplasts are being tested on melanoma patients now, because they specifically block the cancer tumors ability to build blood vessels.

Hence, if you have been diagnosed with melanoma, you may want to consider lowering your iron intake. It should be noted, however, that some doctors will tell you that lowering your iron is the wrong strategy. This is because some treatments for melanoma (ex. chemotherapy) can lower your red blood cell count during the treatment. Unfortunately, with a treatment like chemotherapy, often the success of the treatment is somewhat proportional to the ability for the patient to finish the entire treatment protocol. However, if a patient’s blood cell counts get too low, your doctor will need to stop the treatment, lowering the chances of success. Hence, some doctors will actually suggest taking iron supplements or infusions prior to treatment to increase your red blood cell count and give you the highest chance of success for finishing the entire protocol. However, keep in mind that there are many other ways to boost red blood cell counts, including certain shots that your doctor can give you. So you may want to consider avoiding iron, and finding other ways to increase your red blood cells.

Requests for additions to this articles

The authors of this article believes there are many other things that can cause cancer to spread, and would like assistance from the FoundHealth community in researching and presenting information in the following topics:

Excessive lymphatic drainage

Growth Hormones

References:

(1) http://leiomyosarcoma.org.uk/biopsies.htm; see the long list of reference articles and studies at the bottom of the article

(2) http://www.karlloren.com/biopsy/p34.htm

(3) http://professional.cancerconsultants.com/news.aspx?id=42773

(4) http://www.dochemp.com/melanoma.html_