Melanoma

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What is melanoma?

Left untreated, melanoma cancer cells can continue to multiply and spread from the skin to other parts of the body, such as the lymph nodes. Melanoma can lead to life-threatening complications and be fatal. If you notice any changes in your skin or in the color, shape or texture of a mole, seek prompt medical care. Early diagnosis and treatment increase the chances that melanoma will be discovered in its earliest, most curable stage.

Melanoma is the most dangerous type of skin cancer because it can spread quickly (metastasize) to other organs of the body. The incidence of melanoma is growing faster than any other type of cancer, primarily because of the popularity of sunbathing and the use of tanning beds.

Melanoma begins in skin cells called melanocytes, which make the pigment that colors skin. Normally, when these cells are old or damaged, they stop dividing and die and are replaced by healthy young cells. Melanoma occurs when old or damaged cells continue to divide and multiply uncontrollably. This results in the development of a malignant mass of tissue (tumor) on the skin.

Most melanomas are brown or black, resembling moles. Melanoma can develop in an existing mole or a freckle, or within normal-appearing skin as well. However, melanomas can also be pink, red, purple, or even the same color as the skin. Malignant melanoma is another name for this cancer.

Who gets melanoma?

In the United States, nearly 100,000 people find out they have melanoma each year. This represents about 5% of all new cancer diagnoses and 1% of all skin cancer diagnoses. The rate of melanoma has been steadily increasing and has doubled in the last 30 years. Here are some additional melanoma statistics and trends:

  • The average age at diagnosis is 63.
  • It is more common in women before age 50. By age 65, men are twice as likely to get melanoma and by age 80, they are three times as likely to get it.
  • It is the most common cancer in adults ages 25 to 29.
  • It is 20 times more common in Caucasians than African Americans. For Caucasians, the lifetime risk is 2.6% or 1 in 38. In African Americans, it is 0.1% or 1 in 1,000. In Hispanics, it is 0.58% or 1 in 172.
  • About 10% of people with melanoma have a family history of the cancer.

What are the different types of melanoma?

The types of melanoma fall into one of two categories: superficial or invasive. Melanoma that is superficial is found in the top layer of skin, is less dangerous, and easier to treat. Invasive melanoma originates deep in the skin. Left untreated, superficial melanoma can become invasive.

The four basic types of melanoma are:

  • Superficial spreading melanoma is the most common type of melanoma. It accounts for about 70% of cases. It grows across the skin for some time before becoming invasive. These cancers are usually flat and vary in color. They typically show up on the trunk for men, legs for women, and upper back, head, and neck for both, but can be anywhere.
  • Nodular melanoma is the second most common type, accounting for about 15% of cases. It is the most aggressive form of melanoma and has usually spread at diagnosis. It typically looks like a bump or dome and is black, but can be other colors. It can appear on just about any skin area.
  • Acral lentiginous melanoma represents about 8% of melanomas. It is the most common form affecting dark-skinned people. It shows up under the nails and on the palms of the hands and soles of the feet. This form is also very aggressive.
  • Lentiginous melanoma accounts for 5% of melanomas. It is similar to superficial spreading melanoma. It can grow across the skin for a while before invading deeper. It also has a similar appearance to the superficial type. However, it usually appears on skin with chronic sun exposure, such as the face, ears, arms, and upper trunk.

What are the stages of melanoma?

Several factors determine the stage of melanoma, including how much the cancer has grown and if it has spread to other body areas (metastasized). Knowing the melanoma stage helps doctors decide how to best treat the melanoma and determine a prognosis for recovery.

There are five stages of melanoma: 0, I, II, III and IV. Higher stages are more advanced disease and generally have a poorer prognosis. Up to stage II, melanoma is only in the skin and has not spread to lymph nodes.

  • Stage 0: This early melanoma is isolated to the outermost layer of skin.
  • Stage I (1): This early melanoma is smaller than 1 mm and has penetrated beneath the top skin layer.
  • Stage II (2): This intermediate or high-risk melanoma tumor is deeper than 1 mm but has not spread, although the risk of spread is high. Thicker tumors larger than 4.0 mm have a higher risk of spreading.
  • Stage III (3): In this advanced melanoma, the cancer has spread to nearby lymph nodes or spread more than 2 cm from the primary tumor.
  • Stage IV (4): This advanced melanoma has spread to distant body areas including lymph nodes, lungs, liver, brain, bone or digestive tract.

Melanoma staging is complex and can be confusing. If you are diagnosed, ask questions. Your doctor is there to explain your diagnosis (and treatment plan) in ways that you can understand.

What are the symptoms of melanoma?

Melanoma can resemble a mole or it can grow within existing moles or freckles. In some cases, melanoma does not produce any change in skin pigmentation or color.

Symptoms of melanoma include:

  • A mole that is asymmetrical. As a test, visually draw a line through the middle of the lesion. If the two halves don’t match, the mole is asymmetrical.
  • A mole with an irregular, scalloped or notched border
  • A mole that is growing or enlarging. A warning sign is a lesion the size of a pencil eraser or larger (6 mm or ¼ inch in diameter).
  • A mole with abnormal coloring or more than one color, such as white, blue, red, black, or brown
  • Any change of a new or existing spot in terms of size, shape, color, elevation, bleeding, itching or crusting

Check yourself and look for anything new, changing or unusual anywhere on the skin, including places that get no sun exposure. Report any spot that just doesn’t look right to your doctor or dermatologist promptly.

What does melanoma look like?

Identifying potential skin cancer can be challenging especially in the early stages. Melanoma can take on a few or many mixed characteristics. Bottom line is if you notice anything out of the ordinary on your skin or new changes, promptly make an appointment with your doctor or dermatologist.

Photos of Melanoma

Large, asymmetrical melanoma with irregular border, uneven color, and scaly area.

Skin cancer
Large, asymmetrical melanoma with irregular border, raised areas, and uneven color.

close up picture of finger pointing at dysplastic brown nevus (atypical mole) on human skin
Getty
A mole that is growing or enlarging with uneven color, pigment spreading to the surrounding skin area, and an irregular border should be evaluated for melanoma.

What causes melanoma?

Nearly 90% of melanoma cases are the result of exposure to ultraviolet (UV) light. This includes exposure to natural sunlight and tanning bed lights. UV light damages skin cells, including healthy pigment-generating melanocytes, which can cause them to grow uncontrollably.

While anyone can get melanoma, certain things increase the risk, including bad sunburns, fair complexion, and family history of melanoma.

What are the risk factors for melanoma?

A number of factors are thought to increase your chances of developing melanoma. Not all people who are at risk for melanoma will develop the cancer.

Risk factors for melanoma include:

  • BRAF gene mutation, which is present in about half of all melanomas
  • Excessive sun exposure
  • Exposure to UV radiation in tanning beds
  • Fair skin that is freckled or does not tan
  • Family history of melanoma—having a first-degree relative with melanoma increases the risk by 50%
  • Large number of moles (50 or more) or more than one abnormal mole (dysplastic mole)
  • Personal history of other types of skin cancer—having melanoma once increases the risk of recurrence. Having xeroderma pigmentosum, a type of skin disease that can cause melanoma, also increases the risk.
  • Red or blond hair and blue or green eyes
  • Repeated sunburns, especially blistering sunburns, or just one very bad sunburn in childhood—having five or more blistering sunburns during teenage years increases the risk of melanoma by 80%
  • Weakened immune system due to such conditions as HIV/AIDS, cancer, or taking medications that suppress the immune system

How do you prevent melanoma?

You may be able to prevent or lower your risk of melanoma by:

  • Avoiding excessive exposure to the sun throughout your lifetime
  • Avoiding sun exposure during the period of time when the sun’s rays are strongest, generally between 9 a.m. and 4 p.m.
  • Frequently applying sunscreen with a high SPF as directed when in the sun
  • Not using tanning beds
  • Seeking regular medical care so that moles and skin changes can be assessed and monitored
  • Wearing UV-protective clothing during long periods of sun exposure, including long sleeves, pants, and wide-brimmed hats

How do doctors diagnose melanoma?

Performing regular skin self-exams can help you find concerning concern spots and seek medical care. Regular medical care allows a healthcare professional to best evaluate your risks of developing melanoma, perform skin exams, and promptly order diagnostic testing for such symptoms as an enlarging or abnormal mole. These measures greatly increase the chances of discovering melanoma in its earliest, most curable stage.

A biopsy is the only way to know for certain if a suspicious skin lesion is cancerous. Biopsy techniques include shaving off a layer of skin, punching out a core of deeper skin layers, and cutting out a wedge of skin.

A pathologist will examine the samples under a microscope to see if melanoma is present. Information from the pathology report helps doctors stage the cancer.

For a complete diagnosis, your doctor may order testing of nearby lymph nodes or imaging exams (CT or MRI) to determine if the melanoma has spread. Other tests include blood tests and genetic tests. Information from all these tests help your doctor determine the type and stage of the cancer and determine the most effective treatment plan.

How is melanoma treated?

The goal of melanoma treatment is to bring about a complete remission of the disease. Remission means there is no longer any sign of the disease in the body, although it may recur or relapse later.

Melanoma treatment plans are multifaceted and individualized to your age, medical history, coexisting diseases and conditions, and the type of melanoma and its stage of advancement.

Up to stage II (2), cancer is only in the skin and has not spread to lymph nodes. Melanoma treatment for these stages involves removing the cancer and some healthy skin around it. Other treatment options include chemotherapy, radiation therapy, targeted therapy, and immunotherapy. In later stages, targeted therapy and immunotherapy for melanoma can help people live longer.

Melanoma treatment options include an individualized combination of:

  • Surgery to remove the cancerous tumor and surrounding skin. It is the primary treatment for all stages.
  • Chemotherapy for cases of melanoma that has spread beyond the skin to the lymph nodes and other parts of the body
  • Targeted therapy or immunotherapy for cases of melanoma that has spread beyond the skin to the lymph nodes and other parts of the body
  • Pain medications as needed
  • Radiation therapy may be appropriate for patients who cannot have surgery. Radiation is also used for later stages to relieve symptoms and improve quality of life
  • Participation in a clinical trial to test promising new therapies and treatments for melanoma
  • Physical therapy to help strengthen the body, increase alertness, reduce fatigue, and improve functional ability during and after cancer treatment
  • Dietary counseling to maintain strength and nutritional status

Complementary treatments

Some complementary treatments may help some people to better deal with melanoma and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care.

Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Massage therapy
  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
  • Yoga

Hospice care

In cases in which melanoma has progressed to an advanced stage and has become unresponsive to treatment, the goal of treatment shifts away from curing the disease and focuses on measures to keep a person comfortable and maximize the quality of life.

Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient’s family. It is sometimes called palliative care.

How does melanoma affect quality of life?

Melanoma has a similar effect on quality of life (QoL) as other cancers. However, there can be differences between people with early, highly curable disease and those with regional or distant spread. Overall, about one-third of patients experience very high levels of distress, which decreases QoL. Levels are highest at the time of diagnosis and level out over time. This is important because decreased QoL can affect recovery and possibly even disease progression.

Predictors of low QoL include poor overall health, poor psychological health, and low levels of social support. Women also report higher levels of anxiety than men.

Trends in health-related quality of life for melanoma include:

  • About 41% of melanoma patients report emotional health issues including worry, concern, embarrassment, self-consciousness, fear, and thoughts of death.
  • About 28% report lifestyle limitations including leisure and social activities, physical functioning, general functioning, and personal care.
  • About 20% report that having to make changes, such as modified clothing choices or avoidance or protection from sun exposure, lowered their QoL.

Research shows cognitive behavioral therapy can greatly relieve distress related to melanoma. Identifying melanoma patients with poor QoL at diagnosis and offering them counseling may improve their treatment journey and well-being.

What are the potential complications of melanoma?

Complications of melanoma are life threatening. Complications are caused by a rapid growth of abnormal cells. These cells can travel through the bloodstream and lymphatic system to other areas of the body, most often the bones, lungs and liver. There they can multiply rapidly and develop new malignant tumors that interfere with the normal organ function.

You can best treat melanoma and lower your risk of complications by following the treatment plan you and your health care professional design specifically for you.

Complications of melanoma metastasis include:

  • Adverse effects of anticancer treatment
  • Disfigurement from tumor resection
  • Higher risk of developing breast cancer
  • Local recurrence of melanoma
  • Skin tissue damage to the deep layer of the skin
  • Spread of cancer to the lymph nodes and other organs where it interferes with normal organ function

What is the survival rate and prognosis for melanoma?

Melanoma is highly treatable and commonly curable when found early. It becomes much more dangerous and life threatening once it has spread. About 7,000 people die of melanoma annually. However, death rates from melanoma are falling and have decreased over the last 10 years.

Doctors describe melanoma survival using a 5-year relative survival rate. This rate looks at people with the same type and stage of cancer five years after the original diagnosis. It compares them to the overall population of the same age and sex. This comparison shows how much a disease can shorten life.

Here are the rates for melanoma:

  • When melanoma has not spread at all, the 5-year relative survival rate is 98%.
  • With regional spread to nearby structures or lymph nodes, the rate is 64%.
  • With spread to distant body sites (advanced, metastatic melanoma), the rate drops to 23%.

Keep in mind survival rates are only statistics. They can’t tell you how long a person will live. Prognosis depends on many factors, including age and overall health. Melanoma treatments are also continually improving, which will improve survival as well.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 23
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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