Melanoma

Overview

What is melanoma?

Melanoma, which means "black tumor," is the most dangerous type of skin cancer. It grows quickly and has the ability to spread to any organ.

Melanoma comes from skin cells called melanocytes. These cells produce melanin, the dark pigment that gives skin its color. Most melanomas are black or brown in color, but some are pink, red, purple or skin-colored.

About 30% of melanomas begin in existing moles, but the rest start in normal skin. This makes it especially important to pay attention to changes in your skin because the majority of melanomas don't start as moles. However, how many moles you have may help predict your skin’s risk for developing melanoma. It’s important to know if you’re in a high-risk group for developing melanoma skin cancer. Because of the fast growth rate of melanomas, a treatment delay sometimes may mean the difference between life and death. Knowing your risk can help you be extra vigilant in watching changes in your skin and seeking skin examinations since melanomas have a 99% cure rate if caught in the earliest stages. Early detection is important because treatment success is directly related to the depth of the cancerous growth.

How common is melanoma?

Melanoma accounts for only about 1% of all skin cancers, but causes the great majority of skin cancer-related deaths. It’s one of the most common cancers in young people under 30, especially in young women.

Melanoma incidence has dramatically increased over the past 30 years. It’s widely accepted that increasing levels of ultraviolet (UV) exposure are one of the main reasons for this rapid rise in the number of melanoma cases.

Where can I get melanoma on my body?

You can get melanoma on any area of your body. Melanoma can even form on your eyes and internal organs. Men are more prone to develop melanoma on their trunk — often the upper back. Women are more likely to have melanoma on their legs.

What are the signs of melanoma?

Knowing how to spot melanoma is important because early melanomas are highly treatable. Melanoma can appear as moles, scaly patches, open sores or raised bumps.

Use the American Academy of Dermatology's "ABCDE" memory device to learn the warning signs that a spot on your skin may be melanoma:

  • Asymmetry: One half does not match the other half.
  • Border: The edges are not smooth.
  • Color: The color is mottled and uneven, with shades of brown, black, gray, red or white.
  • Diameter: The spot is greater than the tip of a pencil eraser (6.0 mm).
  • Evolving: The spot is new or changing in size, shape or color.

Some melanomas don't fit the ABCDE rule, so tell your doctor about any sores that won't go away, unusual bumps or rashes or changes in your skin or in any existing moles.

Another tool to recognize melanoma is the ugly duckling sign. If one of your moles looks different from the others, it’s the ugly duckling and should be seen by a dermatologist.

Symptoms and Causes

What causes melanoma?

Most experts agree that a major risk factor for melanoma is overexposure to sunlight, especially sunburns when you are young. Statistics tell us that 86% of melanomas are caused by solar ultraviolet (UV) rays. How does the sun cause skin cancer? UV exposure can cause damage to a cell’s DNA, making changes to particular genes that affect how cells grow and divide. The potential for problems comes when your skin's DNA is damaged and those cells start reproducing.

UV radiation from tanning beds also increases the risk of melanoma and has been designated as a carcinogen (cancer-causing) by the World Health Organization. Tanning bed use may be related to over over 6,000 cases of melanoma per year in the United States.

Although anyone can develop melanoma, an increased risk for developing the disease is seen in people with:

  • A personal history of melanoma.
  • A family history of melanoma.
  • Fair skin, freckles, blond or red hair and blue eyes.
  • Excess sun exposure, including blistering sunburns.
  • An address near the equator or in high elevations — living in these locations may increase your UV exposure.
  • A history of tanning bed use.
  • Many moles, especially atypical moles.
  • A weakened immune system.

Melanoma is more common in white people, but it can occur in people of all skin types. People with darker skin most often get melanoma on their palms, soles and nails.

Diagnosis and Tests

How is melanoma diagnosed?

If you have a mole or other spot that looks suspicious, your doctor may remove it and look at it under the microscope to see if it contains cancer cells. This is called a biopsy.

After your doctor receives the skin biopsy results showing evidence of melanoma cells, the next step is to determine if the melanoma has spread. This is called staging. Once diagnosed, melanoma will be categorized based on several factors, such as how deeply it has spread and its appearance under the microscope. Tumor thickness is the most important characteristic in predicting outcomes.

Melanomas are grouped into the following stages:

  • Stage 0 (Melanoma in situ): The melanoma is only in the top layer of skin (the epidermis).
  • Stage I: Low-risk primary melanoma with no evidence of spread. This stage is generally curable with surgery.
  • Stage II: Features are present that indicate higher risk of recurrence, but there is no evidence of spread.
  • Stage III: The melanoma has spread to nearby lymph nodes or nearby skin.
  • Stage IV: The melanoma has spread to more distant lymph nodes or skin or has spread to internal organs.

What tests are used to stage melanoma?

There are several tests your doctor can use to stage your melanoma. Your doctor may use these tests:

  • Sentinel Lymph Node Biopsy: Patients with melanomas deeper than 0.8 mm, those who have ulceration under the microscope in tumors of any size or other less common concerning features under the microscope, may need a biopsy of sentinel lymph nodes to determine if the melanoma has spread. Patients diagnosed via a sentinel lymph node biopsy have higher survival rates than those diagnosed with melanoma in lymph nodes via physical exam.
  • Computed Tomography (CT) scan: A CT scan can show if melanoma is in your internal organs.
  • Magnetic Resonance Imaging (MRI) scan: An MRI scan is used to check for melanoma tumors in the brain or spinal cord.
  • Positron Emission Tomography (PET) scan: A PET scan can check for melanoma in lymph nodes and other parts of your body distant from the original melanoma skin spot.
  • Blood work: Blood tests may be used to measure lactate dehydrogenase (LDH) before treatment. Other tests include blood chemistry levels and blood cell counts.

Management and Treatment

How is melanoma treated?

Your melanoma treatment will depend on the stage of the melanoma and your general health.

Surgery is usually the main treatment for melanoma. The procedure involves cutting out the cancer and some of the normal skin surrounding it. The amount of healthy skin removed will depend on the size and location of the skin cancer. Typically, surgical excision (removal) of melanoma can be performed under local anesthesia in the dermatologist's office. More advanced cases may require other types of treatment in addition to or instead of surgery.

Treatments for melanoma:

  • Melanoma Surgery: In the early stages, surgery has a high probability of being able to cure your melanoma. Usually performed in an office, a dermatologist numbs the skin with a local anesthetic and removes the melanoma and margins (healthy surrounding skin).
  • Lymphadenectomy: In cases where melanoma has spread, removal of the lymph nodes near the primary diagnosis site may be required. This can prevent the spread to other areas of your body.
  • Metastasectomy: Metastasectomy is used to remove small melanoma bits from organs.
  • Targeted cancer therapy: In this treatment option, drugs are used to attack specific cancer cells. This “targeted” approach goes after cancer cells, leaving healthy cells untouched.
  • Radiation Therapy: Radiation therapy includes treatments with high-energy rays to attack cancer cells and shrink tumors.
  • Immunotherapy: immunotherapy stimulates your own immune system to help fight the cancer.

Some patients with skin cancer may participate in a clinical trial. A clinical trial is a research program conducted with patients to evaluate a medical treatment, drug or device.

Prevention

Can melanoma be prevented?

You may reduce your risk of melanoma by protecting yourself from excess sun and sunburns.

  • Avoid sun and seek shade, especially between 10 a.m. and 4 p.m.
  • Don’t use tanning beds. Use a spray tan (cosmetic) instead.
  • Whenever possible, wear hats with brims, sunglasses, long-sleeved shirts and pants.
  • Use a broad-spectrum sunscreen with a skin protection factor (SPF) of 30 or higher and reapply often, usually every 1.5 hours or more often if you’re swimming or sweating.
  • Use a lip balm with sunscreen.
  • Don't forget to apply sunscreen to young children and infants older than 6 months.

Early detection is important to minimize the risks associated with melanoma. Be sure to tell your doctor about any new or changing moles, sores or skin discolorations. In addition, ask your doctor to routinely perform a total skin examination to look for signs of skin cancer.

Can changing my diet help prevent melanoma?

The American Cancer Society advocates eating a plant-based diet over an animal-based diet as part of a healthy plan to avoid all cancers. Growing evidence suggests that plants pack a powerful punch in any fight against cancer because they're nutritious, cholesterol-free and fiber-rich.

There’s no doubt that a healthy diet can protect your immune system. Having a strong immune system is important to help your body fight disease. Some research has shown that a Mediterranean diet is a healthy choice that may help prevent the development of cancer. Talk to your healthcare provider about the role food plays in lowering your cancer risks.

Some skin and immune-system healthy foods to consider include:

  • Daily tea drinking: The polyphenols (antioxidants found in plants) in tea help strengthen your immune system. Green tea contains more polyphenols than black tea.
  • High vegetable consumption: Eating carrots, cruciferous and leafy vegetables is linked to the prevention of cutaneous (invasive) melanoma.
  • Weekly fish intake: Study participants who ate fish weekly seemed to avoid developing the disease when compared to those who did not eat fish weekly.

Following years of debate among dermatologists over the protective effects of antioxidants in preventing skin cancer, recent research shows a link between antioxidant intake from fresh foods and not developing the disease. Antioxidants in supplements have not been proven effective as a skin cancer prevention. More dermatologists today recommend a diet rich in high-antioxidant whole foods.

Outlook / Prognosis

What is the outlook for people with melanoma?

Most skin cancers can be cured if they’re treated before they have a chance to spread. However, more advanced cases of melanoma can be fatal. The earlier skin cancer is found and removed, the better your chances for a full recovery.

Living With

When should I call my doctor?

You should have a skin examination by a doctor if you have any of the following:

  • A personal history of skin cancer or atypical moles (nevi).
  • A family history of skin cancer.
  • A history of intense sun exposure as a young person and painful or blistering sunburns.
  • New or numerous large moles.
  • A mole that changes in size, color or shape.
  • Any mole that itches, bleeds or is tender.

A note from Cleveland Clinic

Receiving a diagnosis of melanoma can be scary. Watch your skin and moles for any changes and seeing your doctor regularly for skin examinations, especially if you’re fair-skinned, will give you the best chances for catching melanoma early when it’s most treatable.

Last reviewed by a Cleveland Clinic medical professional on 06/21/2021.

References

  • National Cancer Institute. . Accessed 6/12/2020.Skin Cancer (Including Melanoma) (https://www.cancer.gov/types/skin)
  • American Academy of Dermatology. Accessed 6/12/2020.Melanoma. (https://www.aad.org/public/diseases/skin-cancer/melanoma#causes)
  • American Cancer Society. Accessed 6/12/2020.About Melanoma Skin Cancer. (http://www.cancer.org/cancer/skincancer-melanoma/overviewguide/index)
  • Cleveland Clinic Center for Continuing Education. Disease Management: Melanoma. Accessed 6/15/2020.
  • AIM at Melanoma Foundation. Accessed 6/15/2020.Sentinel Lymph Node Biopsy. (https://www.aimatmelanoma.org/diagnosing-melanoma/sentinel-lymph-node-biopsy/)
  • American Cancer Society. Accessed 6/15/2020.Tests for Melanoma Skin Cancer. (https://www.cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/how-diagnosed.html)
  • Pandel R, Poljšak B, Godic A, Dahmane R. ISRN Dermatol. 2013;2013:930164. Published 2013 Sep 12. doi:10.1155/2013/930164Skin photoaging and the role of antioxidants in its prevention. (https://www.hindawi.com/journals/isrn/2013/930164/)
  • The Skin Cancer Foundation. Accessed 6/15/2020.Can Your Diet Help Prevent Skin Cancer? (https://www.skincancer.org/blog/can-your-diet-help-prevent-skin-cancer/)
  • C Fortes, S Mastroeni, F Melchi, M A Pilla, G Antonelli, D Camaioni, M Alotto, P Pasquini. International Journal of Epidemiology, Volume 37, Issue 5, October 2008, Pages 1018–1029.A protective effect of the Mediterranean diet for cutaneous melanoma. (https://doi.org/10.1093/ije/dyn132)
  • American Cancer Society. Accessed 6/18/2020.ACS Guideline for Diet and Physical Activity. (https://www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html)

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