Melanoma

Melanoma is a type of skin cancer that develops when malignant (cancerous) cells form in your melanocytes. Melanocytes are cells that make melanin, which is a dark pigment that gives skin its color. It isn’t the most common type of skin cancer. But it’s the most dangerous type because it grows quickly and can spread (metastasize) through your body without treatment.

Melanoma (pronounced “mel-uh-NOH-muh”) is more common in people who have lighter skin. It can start anywhere on your skin, including existing moles. But it most commonly appears on areas that get a lot of sun exposure. This includes your:

• Face
• Neck
• Chest
• Back
• Arms
• Legs

It can also occur on the bottom of your hands and feet, especially if you have darker skin.

When healthcare providers catch melanoma early, it’s very treatable with surgery or cancer therapies. Pay attention to your skin. If you notice any changes, like a new or changing mole, reach out to a healthcare provider.

Types

Healthcare providers identify the different types of melanoma according to where they appear on your body. These include:

• Superficial spreading melanoma: This is the most common type. Melanomas usually appear as dark spots on the surface of your skin.
• Nodular melanoma: This is a firm, dome-shaped growth on your skin. It grows above and below your skin surface.
• Ocular melanoma: This type forms on or in your eye.
• Mucosal melanoma: This type starts in soft tissue (mucosa) in your body, such as your nose or lips.
• Spitzoid melanoma: This type looks like a discolored (pink, brown or black) or skin-colored mole. It’s more common in children than adults.
• Subungual melanoma: This type usually appears as a dark spot under your nail.
• Amelanotic melanoma: This type doesn’t look dark. It’s easy to confuse it as a pimple or scar because it looks light (pink, red or white on the surrounding skin).
• Acral melanoma: This type appears on the palms of your hands, soles of your feet or under your nails.

Symptoms of melanoma

The first symptoms are usually skin changes. These may include changes to an existing mole or a pigmented area, or the development of:

• Scaly patches
• Raised bumps
• Open sores, which may not go away
• A mole that looks different from other moles (“ugly duckling” sign)

If you have darker skin, you may notice changes on your palms, soles and nails.

The ABCDEs of melanoma can help identify warning signs of melanoma. These include:

• Asymmetry: One half of a mole or spot doesn’t match the other.
• Border: Uneven edges that aren’t smooth. They may look irregular or ragged.
• Color: It’s blotchy and uneven, with shades of brown, black, gray, red, blue or white.
• Diameter: It’s bigger than the tip of a pencil eraser (around 0.25 inches or 6 millimeters).
• Evolving: The spot is new or changing in size, shape or color. Be aware if it begins to bleed, itch or crust over.

Causes of melanoma

Getting too much ultraviolet (UV) light is the main cause of melanoma. UV light comes from the sun. But you can also get it from artificial sources, like tanning beds.

Genetic variations can also cause melanoma, especially the types that affect your eyes or mucosa.

Risk factors

Anyone of any age and skin type can develop melanoma. But you’re at a greater risk if you:

• Have a personal or biological family history of melanoma
• Have light skin, freckles, blue or green eyes or blond or red hair
• Have a history of severe, blistering sunburns
• Live in areas that get a lot of direct sunlight, like near the equator or at a higher elevation
• Use tanning beds
• Have a lot of moles, especially atypical moles
• Have a weakened immune system

How doctors diagnose melanoma

Your healthcare provider will first review your medical history, ask about any symptoms and conduct a physical exam. During the physical exam, if they notice moles or other spots that look suspicious, they’ll remove them (biopsy) and send them to a lab. There, a pathologist will examine them for signs of cancer.

If your biopsy results show melanoma, your provider will recommend tests to help stage it. These may include blood work and tests to check for melanoma in other parts of your body, like:

• Imaging tests, including a CT scan, MRI or PET scan
• Sentinel node biopsy

Melanoma stages

Healthcare providers group melanomas into the following stages:

• Stage 0 (melanoma in situ): The melanoma is only in the top layer of skin.
• Stage I (1): This is low-risk primary melanoma. There’s no evidence that it has spread.
• Stage II (2): The melanoma has features that indicate there’s a higher risk that it may come back. But there’s no evidence that it has spread.
• Stage III (3): The melanoma has spread to nearby lymph nodes or skin.
• Stage IV (4): The melanoma has spread to more distant lymph nodes or skin or internal organs.

How is melanoma treated?

Your treatment depends on the cancer stage and your overall health.

Surgery is usually the main treatment. Your healthcare provider will remove the melanoma and some healthy tissue around it. They can usually perform surgery in their office and only numb the treatment area. In cases where melanoma has spread, you may need a more involved surgery. Your provider may need to surgically remove your lymph nodes or parts of any affected organs.

More advanced melanoma may need treatments like:

• Immunotherapy: This involves drugs that boost your immune system to help fight cancer.
• Targeted therapy: Your provider gives you drugs that target cancer cells without affecting healthy cells.
• Chemotherapy: You receive drugs that destroy cancer cells and prevent them from spreading.
• Radiation therapy: Your provider uses radiation to kill cancer cells.

When should I see my healthcare provider?

Reach out to a healthcare provider for a physical exam if you have any skin changes. It’s also a good idea to schedule an appointment if you notice new moles.

What can I expect if I have melanoma?

With an early diagnosis and treatment, your outlook is good.

Healthcare providers can cure most skin cancers if they treat them before they have a chance to spread. But more advanced cases of melanoma can be fatal.

Your provider will give you a better idea of what to expect.

What’s the melanoma survival rate?

The five-year survival rates depend on whether it has spread beyond the area in which it started:

• If it hasn’t spread, the survival rate is greater than 99%.
• If it spreads to nearby lymph nodes, skin or other body parts, the survival rate is 76%.
• If it has spread to distant areas or organs in your body, the survival rate is 36%.

Can melanoma be prevented?

You can help reduce your risk by:

• Avoiding direct sunlight, especially between 10 a.m. and 4 p.m.
• Avoiding tanning beds
• Applying a broad-spectrum sunscreen with a skin protection factor (SPF) of 30 or higher and reapplying often
• Wearing protective clothing, including hats with brims, sunglasses, long-sleeved shirts and pants
• Using lip balm with SPF
• Scheduling an appointment with a healthcare provider as soon as you notice any skin changes