Glossary

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A

Acral

An adjective referring to the extremities, especially the distal extremities of the body. This could be in reference to areas such as fingers, hands, arms, feet, toes and ears.

Adjuvant

A pharmacological agent added to a drug to increase or aid its effect. This can also be an additional treatment used to increase the effectiveness of the main treatment, such as radiation following surgery.

Anaesthetic

Is a drug that can induce the absence of pain and other sensations, and also paralysis if used on specific nerve pathways. This effect is reversible. In surgery, this can help the patient avoid unnecessary discomfort and trauma, and make it easier for the surgeon to undertake the procedure.

Axilla

The anatomical name for the armpit.

Axillary lymph node clearance

This involves the surgical removal of all the lymph nodes and possible tumour-containing tissue in the armpit region of the body.

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B

Benign tumour

A benign tumour is one that is unable to invade neighbouring tissue or metastasise - otherwise known as a non cancerous tumour. For a tumour to be defined as cancerous it must be invasive and able metastasise; therefore benign tumours are non-cancerous.

Biopsy

A process of removing tissue from a living body to discover the presence, cause, or extent of a disease for diagnostic purposes.

This gives a medical team results on which to base further treament decisions for patients and to determine which of those treatments is appropriate.

Blinded study

A study in which information about the test or treatment that might lead to bias in the results is concealed from the treatment team, the patient, or both.  This aims to eliminate the possibility of conscious or unconscious bias.

This can be important in clinical trials, where it is absolutely necessary to demonstrate the efficacy of the drug or treatment being tested, free of all possibility of taint from preconceived ideas, placebo or nocebo effects, or observer bias. 

Bowel

The small and large intestines.

BRAF

BRAF is a human gene that makes a protein called B-Raf. It is involved in sending signals inside cells which direct their growth.  In some cancers, this gene has mutated.  Drugs that target these mutations and thereby treat these cancers have been developed, such as vemurafenib and dabrafenib in melanoma.

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C

C-KIT

C-KIT is a protein. It is found on the surface of a number of different cell types, and can cause some blood cell types to grow through binding to stem cell factor.  Mutated forms of this protein are found in certain cancers and drugs to target these mutations are being developed.  

Catheter

A flexible tube inserted through a narrow opening into a body cavity or vessel to allow passage for fluids.

Cervical Lymph Node Clearance

Surgical removal of the lymph nodes in the neck region.

Chemotherapy

The treatment of a disease (usually cancer) using specific chemical agents or drugs that are destructive to specific cells and tissues.  These drugs are intended to destroy cancer cells or slow down their growth.

Clavicle

Anatomical term for the collarbone.

This is a flat bone that serves as a strut between the scapula and the sternum, lying horizontally. It makes up part of the shoulder and the pectoral girdle, and is palpable in all people; in people who have less fat in this region, the location of the bone is clearly visible, as it creates a bulge in the skin.

Clinical trial

Clinical trials are research studies where volunteers agree to help test new treatments, interventions or tests to find better ways to prevent, detect, treat or manage illness or conditions.  Responses to treatment as well as side effects are investigated.  This information helps to demonstrate whether the new treatment or test is effective, is safe for patients, and if it is an improvement on what is currently being used. 

The World Health Organization (WHO) definition for a clinical trial is ‘any research study that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes’.
Clinical trial interventions may include:

  • experimental drugs
  • cells and other biological products
  • vaccines
  • medical devices
  • surgical and other medical treatments and procedures
  • psychotherapeutic and behavioural therapies
  • health service changes
  • preventive care strategies and
  • educational interventions.

New ways to diagnose, screen for or detect disease may also be investigated in clinical trials.

CT scan

Abbreviation for computed tomography scan. A x-ray tube spins around the patient at high speed, passing through the body to hit detectors on the other side.  The detectors are linked to a computer which then generates images from the information received.  In this way, a CT scan is able to generate images of internal organs which are not possible with conventional x-ray.  Images as thin as 1mm can be generated in slices (“tomograms”), and they can be displayed as 3-D images or a number of display panes.  Although the radiation dose for the patient is much higher than with a conventional x-ray, it is possible to obtain much more information about that which is being scanned than would be otherwise possible. 

Cutaneous

Relating to or affecting the skin.

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D

Dermatologist

A medical doctor who specialises in the diagnosis and treatment of skin disorders. Also commonly used to inspect high risk patients for signs of melanoma or melanoma recurrence.

Dermatology

The medical specialty concerned with the diagnosis and treatment and study of skin disorders.  This may also involve the relationship between cutaneous lesions and more systemic disease.

Dermis

The inner layer of the two layers of cells which create the skin; contains blood capillaries, nerve endings, sweat glands, hair follicles, and other structures.

Dermoscopy

The dermoscope is a special lens that allows to see more features then naked eyes. It is a screening tool to diagnosed melanoma and skin cancers at early stage. Dermoscopy has greatly improved diagnostic accuracy and reduced the need to excise many naevi (moles).

DNA

This is the abbreviation for deoxyribonucleic acid.  This nucleic acid contains doxyribose as the sugar component found primarily in the nuclei and mitochondria of animal and plant cells, and is the self-replicating component.  Essentially, DNA carries genetic information that guide the development of all known living things.  

Donor site

The portion of the body from which an organ or tissue is removed for transplant or grafting.

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E

Epidermis

The outermost of the two main layers of cells that make up the skin.

It is predominantly consisting of flat, scale-like cells called squamous cells. Under these are round cells, called basal cells. The deepest part of this layer contains melanocytes, which produce melanin.  Melanin is what gives skin its color.

Excised tissue

Tissue which is removed surgically.  This may be taken as part of a biopsy, or as part of a wider excision.

Excision

Removal by way of surgery, e.g. Surgical removal of a tumour.

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F

Full thickness skin grafts

A full-thickness skin graft is where a wound is closed with a graft which consists of the epidermis and the entire thickness of the dermis. The donor site may be sutured closed if possible, or covered by a split-thickness skin graft. Full thickness skin grafts are used mainly on the face. Reconstructing an excisional defect with a full thickness of grafted skin can result in an excellent repair as essentially the same tissue that is removed is replaced with donor skin of similar characteristics.

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H

Histopathologist

Histopathology is the examination of tissue under the microscope. The tissue is assessed by a histopathologists, a pathologists who specialises in the assessment of surgical material.  A histopathologist is a medical specialist in this field. 

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I

Iliac

Pertaining to the ilium or pelvic region of the body.

Usually referred to in melanoma patients as the part of the pelvis where lymph nodes are present.

Ilio-inguinal lymph node clearance

Surgical removal of the lymph nodes to the groin and pelvic regions.

Immunosuppressants

An agent that can suppress or prevent the immune response.

Immunosuppressants are used to prevent rejection of a transplanted organ and to treat autoimmune diseases such as psoriasis, rheumatoid arthritis, and Crohn's disease.

Immunotherapy

Treatment to stimulate or restore the ability of the body's immune (defense) system to fight infection and disease.  Sometimes cancer cells are able to appear healthy to the immune system;  immunotherapies help the immune system to recognise them as foreign and to attack them as they would any other threat.  A number of the most recent treatments in melanoma are immunotherapies, including ipilimumab, pembrolizumab, interferon-alpha and interleukin-2.

In-situ

An early stage cancer in which the cancerous growth or tumour is still confined to the site from which it started, and has not spread to surrounding tissue or other organs in the body. 

In melanoma, this is a lesion which  is confined to the cells in the uppermost later (epidermis) of the skin, and has not invaded any deeper. 

Incision biopsy

Where the size of a lesion may make it impractical or cosmetically undesirable to remove the whole lesion, a small section of the lesion may be excised as a biopsy specimen for diagnostic purposes.

Inguinal

An early stage cancer in which the cancerous growth or tumour is still confined to the site from which it started, and has not spread to surrounding tissue or other organs in the body.

In melanoma, this is a lesion which  is confined to the cells in the uppermost later (epidermis) of the skin, and has not invaded any deeper. 

intercostobrachial nerve

These are are cutaneous branches of the intercostal nerves that travel through the armpit region of the body.

Isolated limb infusion (ILI)

This is a form of regional chemotherapy for recurrent disease which is confined to a limb.  It is simpler and as effective as isolated limb perfusion.

Isolated limb perfusion

This is a form of regional chemotherapy for recurrent disease which is confined to a limb.    

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L

Lentigo maligna

Also known as "hutchinson's melanotic freckle", these are atypical pigmented macular lesions which are found on severely sun damaged skin.  They are usually found on the skin of elderly patients.  They can range from being a precursor lesion to melanoma to being in situ melanoma.  

Local Anaesthesia

Local anaesthesia is a type of pain prevention used during minor procedures. The site where pain is likely to occur is numbed, without requiring the patient to become unconscious or unaware. This may be safer for the patient than general anaesthesia in certain circumstances.

Lymph node

A small, oval shaped organ of the lymphatic system that act as filters for foreign particles and cancer cells.

They are distributed widely throughout the body, including the armpit and stomach, and are linked by lymphatic vessels. Lymph nodes are major sites of B, T, and other cells of the immune system. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles and cancer cells, although they do not deal with toxicity. 

Lymph nodes can also indicate the potential presence of disease. They may become inflamed or enlarged in various infections and diseases of varying degrees of severity – from throat infections through to cancers.  Presence or absence of cancer cells in the lymph nodes is used in cancer staging systems, which can suggest prognosis and determine treatment.

Lymphatic system

The lymphatic system is part of the body’s circulatory system, circulating a clear fluid called lymph throughout the body via channels and nodes.  It reincorporates filtered plasma from the cardiovascular system that has not been reabsorbed into the blood but left in the interstitial fluid.  Importantly, the lymphatic system is a defensive part of the immune system.  Unlike blood, lymph contains lymphocytes and other white blood cells.  

Major lymph node groups are mainly found in the neck, armpit and groin. They are responsible for activating the immune system (the body’s defenses) to help overcome infection and to act as a filter against cancer cells.

Melanoma cells which may have spread via the lymphatics from the primary tumour usually occur in the node group nearest to the original melanoma site, e.g. a skin cancer on the hand may spread to the lymph nodes in the armpit, on the foot to the groin, on the trunk it could be to any of the three regions.  

Lymphoedema

If a lymph channel becomes damaged or blocked, eg. by surgery or radiotherapy, lymph fluid is unable to pass from peripheral body parts back to the venous blood circulation via the lymph vessel. Extra fluid builds up in the tissue and gives rise to the condition known as lymphoedema. Lymphoedema can sometimes develop in the arm or the leg following node dissection for the treatment of melanoma. Once lymphoedema has occurred, it can become a permanent condition. It can usually be reduced or controlled by various methods.

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M

Malignant

When referring to cancer, this term means that the cancer is locally invasive, and grows destructively; it also may metastasise (spread) through the body.  Malignant cells can also spread to other parts of the body through the blood and lymph systems.

Margin

The area of healthy tissue removed in surgery that surrounds any diseased tissue and is measured in distance.  Removing a lesion with such a margin assists in reducing the risk of local recurrence by removing melanocytes adjacent to the melanoma which may be prone to it; and also by removing adjacent tissue which may contain tumour cells which have separated from the primary melanoma.

Medical Oncologist

These are cells that produce melanin, which gives skin its colour. They are found in many places in our body, including the skin, hair, eyes and mucous membranes (mouth, nose etc.)

Melanocytes

These are cells that produce melanin, which gives skin its colour. They are found in many places in our body, including the skin, hair, eyes and mucous membranes (mouth, nose etc.)

Melanoma

Melanoma is a malignant cancer that starts from the pigment cells (melanocytes) of the skin. These cells are the cause of freckles and moles on the skin and produce the brown colour of a suntan.

Melanoma grows quickly. If it is not treated, it may spread to the lower layer of skin, where cancer cells can escape and be carried to other parts of the body in blood or lymph vessels.

Though it occurs most commonly on the skin, but can occur anywhere on the body, including the head, neck, the skin under the fingernails, eyes, mouth, nasal passages, genitals and even the soles of the feet or palms of the hands.

Metastases

Plural form of metastasis.

Metastasis

Describes the development of secondary malignant growths at a distance from a primary site of cancer.  This development can occur through transmission of cancerous cells from a primary site to one or more sites elsewhere in the body, usually by way of the blood vessels or lymphatics.  It is an active process by which tumour cells move from the primary location of a cancer by severing connections from the original cell group and establishing remote colonies elsewhere in the body. 

Metastasise

A verb used to describe the spreading of disease from one part of the body to another.

Metastatic

Adjective used to describe cancer that has spread.

MITF

An abreviation for Microphthalmia-associated transcription factor.  This factor controls genes that are involved with normal melanin synthesis in melanocytes, and so mutations in this factor can lead to melanoma as well as other diseases.  Having a mutation in this gene can boost an individual's risk of developing melanoma to around 10%.  Around 4% of Australians carry this gene.  

MRI Scan

Magnetic Resonance Imaging (MRI) is a non-invasive procedure which does not require surgery or use of radiation. An MRI creates detailed internal images of your body which can assist in diagnosis or planning treatment.

Safe and painless, the MRI system creates a magnetic field, sends radio waves into your body, and then measures the response with a computer. This makes a series of detailed images of the inside of your body. The average examination lasts between 25 and 60 minutes.

Similar to CAT scans, MRIs are unable to detect tumours unless the cells are aggregated to produce a physical mass.

Mucosal

Also known as mucous membrane, these are linings of cavities in the body that are exposed to the external environment and internal organs, e.g. The nostrils.  They tend to be soft, moist and pink tissues, sometimes secreting mucus.  

Mutation status

A term used to describe whether or not a patient's tumour carries certain genetic mutations which have been found to be important targets for treatment, e.g. BRAF mutations.

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N

Naevus

Medical term for a mole, or birthmark.  Pigmented cells (melanocytes) aggregate together in groups, and these are called naevi.  Melanocytes and naevus cells do not normally group together to form naevi (moles) until after the first few years of life. Occasionally children are born with pigmented birth marks (congenital naevi).  The development of new naevi (moles) or change in existing ones, especially of single naevi after adolescence is significant and we recommend seeking medical advice.

Neurologist

A medical doctor who specialises in diagnosing and treating non-surgical diseases of the brain and nervous system.

Neurology

The medical specialty concerned with the diagnosis and treatment of disorders of the various nervous systems, as well as where the nervous system connects with the muscular system.  This includes disorders of the brain, spinal cord, and the nerves.

Neurosurgeon

A medical doctor specialising in in surgical procedures to treat brain and nervous system disorders.

Nodular Melanoma

The most aggressive form of melanoma.  Rather than spreading along the skin, this type of melanoma grows vertically from the beginning.  They are usually raised, shaped like a nodule, and have an irregular border and irregular patches of colour.  

NRAS

NRAS is an abbreviation for Neuroblastoma RAS viral [v-ras] oncogene homolog. It is a gene which is involved with making a protein known as N-RAS, which regulates cell division.  When this gene is mutated, it has the potential to cause normal cells to become cancerous.  Some NRAS mutations have been found in melanomas, and hence this mutation may be a target for melanoma therapy. Around 15-20% of melanomas have this gene mutation, and some research suggests that these melanomas are more responsive to immunotherapies.  Some also respond to MEK inhibitors (although not BRAF inhibitors).  

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O

Occult melanoma

An occult melanoma is where the primary tumour is unknown or could not be found, possibly due to regression of the lesion. In some cases, although the melanoma may have disappeared from the skin surface, melanoma cells have still been able to spread further through the body.

Oncogene

A gene which has the potential to cause cancer, often through a mutated form of a normal gene.  

Oncologist

An oncologist is a medical doctor who specializes in treating people with cancer.

The three main types of oncologists are medical, surgical, and radiation oncologists.

These different types of oncologists often work together to treat a person with cancer

Oncology

The medical specialty involving the study of cancer.

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P

Parotid gland

Either of a pair of large salivary glands situated just in front of each ear or the side of the face.

The two parotid glands occur near the mouth and the left ear and the mouth and right ear. They are the largest of the salivary glands.  These glands secrete saliva into the mouth, and help chewing, swallowing and the digestion process. 

Either of a pair of large salivary glands situated just in front of each ear or the side of the face.

The two parotid glands occur near the mouth and the left ear and the mouth and right ear. They are the largest of the salivary glands.  These glands secrete saliva into the mouth, and help chewing, swallowing and the digestion process. 

Parotidectomy

The surgical removal of the parotid gland the major and largest of the salivary glands.

Pathologist

A medical doctor who specialises in the study of disease in body tissues through the examination of materials removed from patients.

Pathology

The medical specialty concerned with the laboratory examination of samples of body tissue for diagnostic or forensic purposes, or to inform treatment decisions. 

PET scan

Positron Emission Tomography (PET) scanning is a unique type of scan that is used in a number of different medical conditions. A small quantity of a radioactive substance (a PET tracer) is injected into the patient and the PET scanner detects important information about a number of different illnesses.

Placebo

A substance having no pharmacological or medical effect but administered as a control or comparison, or in some cases in the absence of more conventional treatment. This may clinically demonstrate the efficacy of a comparison trial drug. 

This drug or medicine may not contain active ingredients which could have a beneficial effect to the patient. The intention is to compare a patient’s reaction to a theoretically ineffective intervention against those of patients who are given the active ingredients, particularly in a trial. In some circumstances a placebo may be intended to deceive a recipient, possibly in the hope that a suggestive effect will assist the patient. Sometimes patients given a placebo treatment will have a perceived or actual improvement in a medical condition, a phenomenon commonly called the placebo effect. 

Primary melanoma

A malignant neoplasm on the skin at the site of origin or where a melanoma is first diagnosed on a patient.

Prognosis

The prediction of the probable outcome or course of a disease.

Punch Biopsy

A punch biopsy is a partial biopsy, which samples a limited amount of a lesion for pathological examination.  These can be used in cosmetically or functionally sensitive areas of the body, or in locations where a complete biopsy may be technically or clinically impractical.  It provides a section of the dermis for examination.  As only a small area is taken, there is a potential for sampling error, leading to incorrect diagnosis.

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R

Radiation Oncologist

A medical doctor who specialises in the treatment of disease with therapeutic radiation.

Radiotherapy

Radiation therapy (sometimes called radiotherapy, x-ray therapy, or irradiation) uses high energy x-rays to kill cancer cells by damaging their DNA (the molecules inside cells that carry genetic information and pass it from one generation to the next).

Radiation therapy can either damage DNA directly or create charged particles (free radicals) within the cells that can in turn damage the DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and eliminated by the body’s natural processes. Radiation therapy can damage normal cells as well as cancer cells. Therefore, treatment must be carefully planned to minimize side effects.

Regional lymph node clearance

The surgical removal of all the lymph nodes and possible tumour-containing tissue in a lymph node field, e.g. The axilla, the groin or the neck.

Regional lymph nodes

Lymph nodes located in a specific anatomic region or compartment, usually known as a lymph node field or lymph node basin.

Regression

In melanoma, regression is a reduction in the size or appearance of the melanoma.   It may be a favourable prognostic factor in Stage I/II melanoma, although it can make it more difficult to stage the melanoma.

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S

Sentinel Lymph Node

A term used to describe the first lymph node to receive lymphatic drainage from the site of a primary tumour. 

Sentinel Node Biopsy

A technique to see if the melanoma has spread to the lymph nodes closest to the original primary melanoma site.  This is an excellent indicator of the prognosis of a patient's melanoma.  A substance containing a small amount of radioactivity is injected into the skin around the tumour. The substance passes into the lymph fluid and is trapped by the sentinel node. That lymph node can be removed and examined to see if there are any cancer cells in it. This technique is usually used for thicker melanomas.

Shave Biopsy

A partial biopsy technique performed with a surgical blade or a razor blade and preferably used only for lesions that are elevated above the skin level or confined to the epidermis and upper dermis.  This kind of partial biopsy may be used in cosmetically or functionally sensitive areas, in patients with significant comobordities, or when the location of a lesion renders a full biopsy technically or clinically impractical.  Shave biopsies may incompletely sample the lesion, hence leading to an incomplete diagnosis. 

Skin graft

If a wound is too big for stitches, a skin graft will be used to cover the wound. A piece of skin is taken from another part of the body and put over the area when the skin tissue is removed. The skin graft may be taken from the thigh or bottom.

Split skin grafts

Split skin grafts are usually used to resurface larger areas where aesthetic considerations are not essential. Split skin grafts use a partial thickness of skin to resurface areas and generally result in a contour defect. Although initially marked, the contour improves substantially over several months as local tissue growth factors modify the region.

Squamous cell carcinoma

Squamous cell carcinoma is the second most common skin cancer. Like melanoma, it can be caused by sun exposure. They only metastasise in around 2% of cases. 

Staging

Staging a melanoma means that the doctor will try to determine the extent of the spread of the disease and whether or not it has moved from the original position on the skin to the lymph nodes or through the bloodstream into other parts of the body.  The American Joint Committee on Cancer Melanoma Staging System is used to predict the prognosis of a melanoma and also to guide treatment. 

Subungual

Situated or occurring underneath a fingernail or toenail.

Subungual melanoma is an uncommon type of melanoma that occurs under the nail bed.  Subungual melanoma may cause a dark coloured stripe that runs along the length of the nail plate, as well as the nail itself.  

Superficial Spreading Melanoma (SSM)

The most common form of melanoma.  In these melanomas, the lesion grows along the surface of the skin for some time before becoming invasive .  It is usually flat or only slightly raised above the level of the surrounding skin. 

Surgical drain

A surgical drain is a tube used to remove pus, blood or other fluids from a wound. They are commonly placed by surgeons or interventional radiologists.  These drains are important so that excess bodily fluids (blood, lymph) do not cause infection or other problems. 

Surgical Oncologist

A surgeon who specialises in the surgical treatment of cancer.  

Suture

The material or thread whereby two surfaces are kept together, i.e. The thread that forms a stitch to close a wound.  

Systemic therapy

Treatment using substances that travel through the bloodstream, thereby affecting the whole body.

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T

T-cell

Another term for t-lymphocytes.  These are responsible for cell-mediated immunity.  They are immune cells that identify, attack and destroy infectious or foreign agents. 

Targeted Systemic therapies

Systemic therapies (i.e. Therapies which circulate through the entire body) which affect a specific genetic target, such as a BRAF or NRAS mutation.  These therapies may also target specific cells in a cancer or which facilitate the cancer's growth or spread in order to attempt to slow or destroy the cancer without affecting surrounding healthy cells and tissues. 

Targeted therapy

These treatments attempt to avoid damaging normal healthy cells by targeting specific cells which may help a cancer to spread;  they may also target the immune system to support it to fight disease.  

Tissue

A group of similar types of cells, as well as the substances that surround them.  These include the skin, nerve tissue and muscle tissue.  

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W

Wide Local Excision

After the initial excision of the melanoma, a wider excision - taking some healthy tissue around the melanoma site - is performed.  This has been shown to reduce the chances of the melanoma recurring or spreading.    This is because the wider excision removes melanocytes adjacent to the skin which may become a melanoma; and also removing any nearby tumour cells which may have spread from the primary melanoma.