Melanoma

Also called malignant melanoma

Skin cancer screening: If you notice a mole that differs from others or one that changes, bleeds, or itches, see a dermatologist.

Melanoma is a type of skin cancer. Anyone can get melanoma. When found early and treated, the cure rate is nearly 100%.

Allowed to grow, melanoma can spread to other parts of the body. Melanoma can spread quickly. When melanoma spreads, it can be deadly.

Dermatologists believe that the number of deaths from melanoma would be much lower if people:

  • Knew the warning signs of melanoma.
  • Learned how to examine their skin for signs of skin cancer.
  • Took the time to examine their skin.

Melanoma: Signs and symptoms

Anyone can get melanoma. It’s important to take time to look at the moles on your skin because this is a good way to find melanoma early. When checking your skin, you should look for the ABCDEs of melanoma.

Signs of melanoma

The most common early signs (what you see) of melanoma are: 

  • Growing mole on your skin.
  • Unusual looking mole on your skin or a mole that does not look like any other mole on your skin (the ugly duckling).
  • Non-uniform mole (has an odd shape, uneven or uncertain border, different colors).

Symptoms of melanoma

In the early stages, melanoma may not cause any symptoms (what you feel). But sometimes melanoma will: 

  • Itch.
  • Bleed.
  • Feel painful.

Many melanomas have these signs and symptoms, but not all. There are different types of melanoma. One type can first appear as a brown or black streak underneath a fingernail or toenail. Melanoma also can look like a bruise that just won’t heal.

Melanoma: Who gets, causes

Who gets melanoma?

Anyone can get melanoma. Most people who get it have light skin, but people who have brown and black skin also get melanoma.

Some people have a higher risk of getting melanoma. These people have the following traits:

Skin

  • Fair skin (The risk is higher if the person also has red or blond hair and blue or green eyes).
  • Sun-sensitive skin (rarely tans or burns easily).
  • 50-plus moles, large moles, or unusual-looking moles.

If you have had bad sunburns or spent time tanning (sun, tanning beds, or sun lamps), you also have a higher risk of getting melanoma.

Men older than 50 are at a higher risk for developing skin cancers, including melanoma. Learning how to check your skin and getting skin exams can help detect skin cancer.

Family/medical history

  • Melanoma runs in the family (parent, child, sibling, cousin, aunt, uncle had melanoma).
  • You had another skin cancer, but most especially another melanoma.
  • A weakened immune system.

More people getting melanoma

Fewer people are getting most types of cancer. Melanoma is different. More people are getting melanoma. Many are white men who are 50 years or older. More young people also are getting melanoma. Melanoma is now the most common cancer among people 25-29 years old. Even teenagers are getting melanoma.

What causes melanoma?

Ultraviolet (UV) radiation is a major contributor in most cases. We get UV radiation from the sun, tanning beds, and sun lamps. Heredity also plays a role. Research shows that if a close blood relative (parent, child, sibling, aunt, uncle) had melanoma, a person has a much greater risk of getting melanoma.

Melanoma: Diagnosis, treatment, and outcome

How do dermatologists diagnose melanoma?

To diagnose melanoma, a dermatologist begins by looking at the patient’s skin. A dermatologist will carefully examine moles and other suspicious spots. To get a better look, a dermatologist may use a device called a dermoscope. The device shines light on the skin. It magnifies the skin. This helps the dermatologist to see pigment and structures in the skin.

The dermatologist also may feel the patient’s lymph nodes. Many people call these lymph glands.

If the dermatologist finds a mole or other spot that looks like melanoma, the dermatologist will remove it (or part of it). The removed skin will be sent to a lab. Your dermatologist may call this a biopsy. Melanoma cannot be diagnosed without a biopsy.

This biopsy is quick, safe, and easy for a dermatologist to perform. This type of biopsy should not cause anxiety. The discomfort and risks are minimal.

If the biopsy report says that the patient has melanoma, the report also may tell the stage of the melanoma. Stage tells the doctor how deeply the cancer has grown into the skin.

The melanoma stages are:

  • Stage 0 - Melanoma is confined to the epidermis (top layer of skin).

  • Stage I - Melanoma is confined to the skin, but has grown thicker. It can be as thick as 1.0 millimeter. In stage IA, the skin covering the melanoma remains intact. In stage IB, the skin covering the melanoma has broken open (ulcerated).

  • Stage II - Melanoma has grown thicker. The thickness ranges from 1.01 millimeters to greater than 4.0 millimeters. The skin covering the melanoma may have broken open (ulcerated). While thick, the cancer has not spread.

  • Stage III - Melanoma has spread to either: 1) one or more nearby lymph node (often called lymph gland) or 2) nearby skin.

  • Stage IV - Melanoma has spread to an internal organ, lymph nodes further from the original melanoma, or is found on the skin far from the orignal melanoma.

Sometimes the patient needs another type of biopsy. A type of surgery called a sentinel lymph node biopsy (SLNB) may be recommended to stage the melanoma. When melanoma spreads, it often goes to the closest lymph nodes first. A SLNB tells doctors whether the melanoma has spread to nearby lymph nodes. Other tests that a patient may need include x-rays, blood work, and a CT scan.

How do dermatologists treat melanoma?

The type of treatment a patient receives depends on the following:

  • How deeply the melanoma has grown into the skin.
  • Whether the melanoma has spread to other parts of the body.
  • The patient’s health.

The following describes treatment used for melanoma. 

Surgery: When treating melanoma, doctors want to remove all of the cancer. When the cancer has not spread, it is often possible for a dermatologist to remove the melanoma during an office visit. The patient often remains awake during the surgical procedures described below. These procedures are used to remove skin cancer:

  • Excision: To perform this, the dermatologist numbs the skin. Then, the dermatologist surgically cuts out the melanoma and some of the normal-looking skin around the melanoma. This normal-looking skin is called a margin. There are different types of excision. Most of the time, this can be performed in a dermatologist’s office.
  • Mohs surgery: A dermatologist who has completed additional medical training in Mohs surgery performs this procedure. Once a dermatologist completes this training, the dermatologist is called a Mohs surgeon.

    Mohs surgery begins with the Mohs surgeon removing the visible part of the melanoma. Next, the surgeon begins removing the cancer cells. Cancer cells are not visible to the naked eye, so the surgeon removes skin that may contain cancer cells one layer at a time. After removing a layer, it is prepped so that the surgeon can examine it under a microscope and look for cancer cells. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less. Mohs has a high cure rate.

When caught early, removing the melanoma by excision or Mohs may be all the treatment a patient needs. In its earliest stage, melanoma grows in the epidermis (outer layer of skin). Your dermatologist may refer to this as melanoma in situ or stage 0. In this stage, the cure rate with surgical removal is nearly 100%. 

When melanoma grows deeper into the skin or spreads, treatment becomes more complex. It may begin with one of the surgeries described above. A patient may need more treatment. Other treatments for melanoma include:

  • Lymphadenectomy: This is surgery to remove lymph nodes.
  • Immunotherapy: Help the patient’s immune system fight the cancer (example: interferon injections).
  • Chemotherapy: Medicine that kills the cancer cells (and some normal cells).
  • Radiation therapy: X-rays kill the cancer cells (and some normal cells).

Other treatment that may be recommended includes:

  • Clinical trial: A clinical trial studies a medicine or other treatment. A doctor may recommend a clinical trial when the treatment being studied may help a patient. Being part of a medical research study has risks and benefits. Before joining a clinical trial, patients should discuss the possible risks and benefits with their doctor. The decision to join in a clinical trial rests entirely with the patient.
  • Palliative care: This care can relieve symptoms and improve a patient’s quality of life. It does not treat the cancer. Many patients receive palliative care, not just patients with late-stage cancer. When melanoma spreads, palliative care can help control the pain and other symptoms. Radiation therapy is a type of palliative care for stage IV (has spread) melanoma. It can ease pain and other symptoms.

Outcome

This depends on how deeply the melanoma has grown into the skin. If the melanoma is properly treated when it is in the top layer of skin, the cure rate is nearly 100%. If the melanoma has grown deeper into the skin or spread, the patient may die.

Melanoma: Tips for finding and preventing

Finding melanoma

Finding melanoma early is important. When melanoma is found early and treated, it is almost 100% curable. This is true even if you have had melanoma. If melanoma spreads, it can be deadly.

Here is what you can do to find melanoma early:

 

  • Check your skin for signs of skin cancer. To help people find melanoma early, the American Academy of Dermatology created the body mole map, which:
    • Illustrates how to examine your skin.
    • Shows you what to look for (ABCDEs of melanoma).
    • Gives you a place to write down where your moles appear on your body.
  • When examing your skin, be sure to check your scalp, feet, nails, and genital area. Melanoma can appear on parts of the body that people do not think to check. 

    And check your scalp, palms, soles, fingernails, and toenails. Melanoma can appear under a nail. Beneath a nail, the most common early warning sign of melanoma  is a brown- to black-colored nail streak. 

    Another early warning sign is a spot that looks like a bruise. The bruise may fade and then come back.

  • Make an appointment to see a dermatologist. If you find a mole or growth on your skin that is growing, unusual, bleeding or not like the rest,
    you should see a dermatologist.

  • Get a free skin cancer screening. The American Academy of Dermatology offers free skin cancer screenings throughout the United States. Most free screenings happen in the spring. 

    If you do not find a screening in your area, you can sign up to receive an email that lets you know when the next free screening will take place in your area.

 

If you have had melanoma

You should know that you have a higher (5 times higher) risk of getting another melanoma. But, there is good news. Finding melanoma early still leads to a high cure rate. You should:

  • Examine your skin for signs of skin cancer.
  • Keep all appointments for follow-up exams. The sooner melanoma or another skin cancer is found, the better the outcome. During follow-up exams, the doctor may do more than look at your skin. You may need to see an eye doctor. Melanoma can develop in the eye. You may need blood work or an x-ray.

Preventing skin cancer

The following can help everyone reduce their risk of getting skin cancer:

  • If you tan, stop. Tanning outdoors, using tanning beds, and sitting under sun lamps are not safe. Research shows indoor tanning increases a person's melanoma risk by 75%. 

    And forget about getting a base tan before going on a tropical vacation. A base tan will not protect you. It just increases your risk for getting skin cancer.

A tan is not a sign of good health. It is a sign that you have damaged your skin.

  • Spend time outdoors when the sun is less intense. Before 10 a.m. and after 2 p.m., the sun’s rays are less intense.

  • Wear sunscreen every day. Even on cloudy, rainy, and snowy days, you need to wear sunscreen. Here what to look for in a sunscreen:
    • A Sun Protection Factor (SPF) of at least 30.
    • UVA and UVB protection.
  • Wear sunglasses that have UV protection. Melanoma can develop in the eyes.

How to apply sunscreen

  • Apply at least 20 minutes before you go outside.
  • Put sunscreen on all skin that will not be covered by clothing.
  • If you spend time outside, reapply the sunscreen every 2 hours.

Support groups:

If you are living with melanoma, you may want to join a support group:

Related resources:

 

 

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