What is Melanoma?
Melanoma is a type of cancer that begins in the melanocytes, or cells that make the pigment melanin. It can develop from a mole and become skin cancer. Other parts of the body, such as the eye or the GI tract also contain melanocytes, and melanoma rarely starts in these areas.
While melanoma is less common than other skin cancers, with about 76,000 new cases diagnosed each year melanoma is the most serious type of skin cancer and can occur on any skin surface. The chance of developing it increases with age, but this disease affects people of all ages.
Having a risk factor does not mean you will develop cancer, but that you are at an increased risk for developing the disease. If you are concerned you have risk factors associated with melanoma, speak with your doctor. Common risk factors for melanoma are:
Fair Skin - Melanoma occurs more frequently in people who have fair skin that burns or freckles easily.
Family History - Melanoma sometimes runs in families. Having a close relative with melanoma increases your risk two to three times more than the average person who does not have a close relative with the disease.
Moles - Having many moles increases the risk of developing melanoma. Atypical moles (dysplastic nevi) are more likely than ordinary moles to become cancerous. Atypical moles are common, and many people have a few of these abnormal moles.
Personal History - People who have been treated for melanoma have a high risk of a second melanoma.
Severe Sunburns - People who have had at least one severe, blistering sunburn as a child or teenager are at increased risk of melanoma. Because of this, doctors advise that parents protect children’s skin from the sun. Sunburns in adulthood are also a risk factor for melanoma.
Ultraviolet (UV) Radiation - Melanoma is more common in people who live in areas that get large amounts of UV radiation from the sun. Artificial sources of UV radiation, such as sunlamps and tanning booths, also cause skin damage and increase the risk of melanoma.
Weakened Immune System - People whose immune system is weakened by certain cancers, by drugs given following organ transplantation, or by HIV are at increased risk of developing melanoma.
Signs and Symptoms
Melanomas in an early stage may be found when an existing mole changes (i.e. when a new black area forms). Newly formed fine scales and itching in a mole are also common symptoms of early melanoma. In more advanced melanoma, the texture of the mole may change.
Melanomas may feel different from regular moles. More advanced tumors may itch, ooze, or bleed. But melanomas usually do not cause pain.
There are five key changes (the ABCDEs of melanoma) to note when looking at a mole:
Asymmetry - The shape of one half of the mole does not match the other.
Border - The mole’s edges are often ragged, notched, blurred, or irregular in outline; the pigment may spread into the surrounding skin.
Color - The mole color is uneven. Shades of black, brown, and tan may be present. Areas of white, grey, red, pink, or blue also may be seen.
Diameter - There is a change in size, usually the mole gets larger. Melanomas are usually larger than the eraser of a pencil (1/4 inch or 5 millimeters).
Evolution - The mole has recently changed in size and/or color.
To detect melanoma early, it is best to perform a skin exam once a month and have a yearly exam with a dermatologist. However, if you feel a mole has developed an abnormality between yearly exams talk with your doctor.
Living with Melanoma
Diagnosis and Staging
Often, a change in the shape, size, color or feel of an existing mole is the first sign of melanoma. It is important to check your skin to see if you notice any new moles, or any changes in moles. If you have any concerns, ask your doctor to check your moles.
Watch out for moles that have a black or blue-black area. Melanoma also may appear as a new mole. It may be black or abnormal. Early stage melanomas can be found when a mole changes slightly. The formation of a new black area, newly formed fine scales, and itching in a mole are common symptoms of early melanoma. In advanced melanoma, the texture might change or the mole may itch, ooze or bleed. Melanomas do not usually cause pain. Often, melanoma can be cured if it is diagnosed and treated early.
If melanoma is not removed in the early stages, cancer cells may grow downward into the skin and can spread to other parts of the body, becoming difficult to control. If your cancer spreads to the bone, visit our bone metastases page. A biopsy is the only way to make a definite diagnosis of melanoma. This can be done two ways:
- Excisional Biopsy - The doctor tries to remove all of the suspicious-looking growth. A pathologist examines the tissue under a microscope to check for cancer cells.
- Biopsy - If the growth is too large to remove entirely, the doctor takes a sample of the tissue. A pathologist examines the tissue under a microscope to check for cancer cells. The biopsy will help inform the doctor about specific factors related to your melanoma, including: thickness, subtype, how fast the cancer cells are dividing, and ulceration.
If you have been diagnosed with melanoma, your doctor will need to know the stage, or extent that the disease has spread in order to plan the best treatment.
Stage 0: In stage 0, the melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.
Stage IA: The tumor is no more than 1 millimeter thick
Stage IB: The tumor is no more than 1 millimeter thick with the outer layer (epidermis) of skin appearing scraped under the microscope. (This is called ulceration).
Stage IIA: The tumor is at least 1-2 millimeters thick with ulceration or 2-4 millimeters thick without ulceration
Stage IIB: The tumor is 2-4 millimeters thick with ulceration or 4 millimeters thick without ulceration
Stage IIC: The tumor is more than 4 millimeters thick with ulceration.
Stage III: The melanoma cells have spread to one or more nearby lymph nodes. Or, the melanoma cells have spread to tissues just outside the original tumor but not to any lymph nodes.
Stage IV: The melanoma cells have spread to other organs, to lymph nodes, or to skin areas far away from the original tumor.
Treatment and Side Effects
If you have been diagnosed, talk through all of your options with your doctor and develop a treatment plan that best fits your needs. Some important questions to ask your doctor as you consider your options:
- What is the type and stage of my melanoma?
- What treatment do you recommend and why?
- Am I eligible for a clinical trial?
- How often will I receive treatment and for how long?
- What is the plan if my disease progresses?
- How often will I need to come in for follow-up care?
- How will treatment affect my quality of life?
- What side effects of treatment should I expect?
- What other resources are available to learn more about my disease and treatment options?
There are several treatment options for melanoma, depending on the extent of the disease and the person’s age and general health. Below is an overview of potential treatment options for melanoma.
Talk to Your Doctor About Clinical Trials
Clinical trials are testing new ways to use or combine drugs or techniques that are already approved or study novel therapies. You or your doctor may be interested in pursuing a clinical trial to help manage your melanoma. Clinical trials offer patients the opportunity to benefit from new combinations of therapies while also advancing the pace of knowledge about the disease and treatment options.
If your doctor has not mentioned a clinical trial as an option, ask if it is right for you. Although there is much information about clinical trials on the internet, it is important to talk with your doctor so you can find the right trial for you. Each trial has specific guidelines and eligibility criteria, including age, exclusions based on prior treatments and stage of your disease. Your doctor or nurse will also be able to explain to you what participating in a clinical will entail and how it may affect your care and daily life.
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