Melanoma

Melanoma

Melanoma is the most serious type of skin cancer. Allowed to grow, melanoma can spread quickly to other parts of the body. This can be deadly.

There is good news. When found early, melanoma is highly treatable.

You can find melanoma early by following this 3-step process:

  1. Learn the warning signs of melanoma.
  2. Look for the warning signs while examining your skin.
  3. See a dermatologist if you find any of the warning signs.

It only takes a few minutes to learn the warning signs. You’ll find everything you need to start examining your skin today on the Body Mole Map.

Signs and Symptoms

Melanoma, the deadliest skin cancer, can show up on your body in different ways. You may see a:

  • Change to an existing mole
  • New spot or patch on your skin
  • A spot that looks like a changing freckle or age spot
  • Dark streak under a fingernail or toenail
  • Band of darker skin around a fingernail or toenail
  • Slowly growing patch of thick skin that looks like a scar

Warning signs to look for

Dermatologists encourage people of all skin colors to perform skin self-exams. Checking your skin can help you find melanoma early when it’s highly treatable. When examining your skin for melanoma, you want to look for the warning signs, which are called the ABCDEs of melanoma :

melanoma skin clinic

If you find anything that looks like it could be melanoma, immediately make an appointment to see a dermatologist. These doctors are the experts at diagnosing skin cancer. Research shows that dermatologists correctly diagnose melanoma more than any other type of doctor.

Symptoms of melanoma

You can have melanoma without feeling any pain or discomfort. For many people, the only sign is a change to their skin, scalp, or nail. Sometimes, melanoma causes one of more of the following:

  • Itch
  • Pain
  • Bleeding

When checking your skin, you want to make sure you check everywhere.

Who gets melanoma?

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

Your risk of getting melanoma increases if you:
Seek the sun, tanning beds, or sunlamps: The sun, tanning beds, and sunlamps emit ultraviolet light (UV). Scientists have proven that UV light can cause skin cancer in people.

Their research also shows you increase your risk of getting melanoma if you:

  • Use tanning beds. Using indoor tanning beds before age 35 can increase your risk of melanoma by 59%, and the risk increases with each use.
  • Had 5 or more blistering sunburns between ages 15 and 20. Research shows this increases one's risk of getting melanoma by 80%.
  • Live close to the equator. Sunlight is more intense there.
  • Live in a sunny area of the United States like Florida or Arizona.
  • Failed to protect your skin from the sun. People older than 65 may experience melanoma more frequently because of UV exposure they've received over the course of their lives. Men older than 50 also have a higher risk of developing melanoma.

While exposure to UV light greatly increases your risk of developing melanoma, your other characteristics also play a role. These include:

Having light-colored skin, hair, or eyes or certain moles: The risk of getting melanoma increases if you have one or more of the following:

  • Fair skin
  • Red or blond hair
  • Blue or green eyes
  • Sun-sensitive skin
  • Skin that rarely tans or burns easily
  • 50 or more moles
  • Large moles
  • An atypical mole (mole that looks like melanoma)

Taking certain medications or having some medical conditions: Your risk of getting melanoma increases if you have:

  • Had melanoma or another type of skin cancer
  • Had another type of cancer, such as breast or thyroid cancer
  • A disease that weakens your immune system, such as acquired immunodeficiency syndrome (AIDS)
  • To take medicine to quiet your immune system, such as taking life-saving medicines to prevent organ rejection after transplant surgery

Have a history of melanoma in your family: If a close blood relative has or had melanoma, you have a higher risk of getting melanoma.

What causes melanoma?

Ultraviolet (UV) light causes melanoma. We get UV light from the sun and tanning beds. Scientists have shown that UV light from the sun and tanning beds can do two things:

  1. Cause melanoma on normal skin.
  2. Increase the risk of a mole on your skin turning into a melanoma.

Scientists have also found that some people inherit genes that increase their risk of getting melanoma.

Because UV exposure is the leading cause of melanoma, you can greatly reduce your risk of getting melanoma by taking steps to prevent skin cancer.

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 original 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.

  • 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: Surgery to remove lymph nodes.
  • Immunotherapy: Treatment that helps the patient’s immune system fight the cancer.
  • Targeted therapy: Drugs that can temporarily shrink the cancer; however, some patients appear to be fully cured.
  • Chemotherapy: Medicine that kills the cancer cells (and some normal cells).
  • Radiation therapy: X-rays that kill the cancer cells (and some normal cells).

Other treatment that may be recommended include:

  • Clinical trial: A clinical trial studies a medicine or other treatment. A doctor may recommend a clinical trial when the treatment being studied could 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.

  • Adoptive T-cell therapy: This treatment uses the patient's immune system to fight the cancer. Instead of receiving medicine, the patient has blood drawn. The blood is sent to a lab so that the T-cells (cells in our body that help us fight cancers and infections) can be removed. These T-cells are then placed in a culture so that they can multiply.

    Once the T-cells are ready, they are injected back into the patient. Some patients with advanced melanoma have had long-lasting remission with this treatment. This therapy, however, is not widely available.

  • 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.

Learn More By Visiting American Academy of Dermatology