Skin Cancer, Melanoma

Melanoma Skin Cancer
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Melanoma is a type of skin cancer. It is the most serious type of skin cancer because melanomas have a tendency to spread quickly to other parts of the body (metastasize).

Melanoma begins when melanocytes (pigment cells) in the skin become more abnormal and start to divide without control or order. These abnormal cells can invade and destroy the normal cells around them. The abnormal cells form a growth of malignant tissue (a cancerous tumor) on the surface of the skin.

Most melanomas appear as dark growths similar to moles, but some may be skin-colored.

Melanoma can begin as a new growth on the skin, or develop from an existing mole (nevi) that changes size, shape, feeling, or color.

Signs and Symptoms of Melanoma

Often, the first sign of melanoma is a change in the size, shape, color, or feel of an existing mole. Most melanomas have a black or blue-black area. Melanoma also may appear as a new mole. It may be black, abnormal, or “ugly looking.”

In more advanced melanoma, the texture of the mole may change. For example, it may become hard or lumpy. Melanomas may feel different from regular moles. More advanced tumors may itch, ooze, or bleed. But melanomas are not usually painful.

Changes in the skin, such as a change in a mole, should be reported to the health care provider right away. The person may be referred to a dermatologist.

A monthly skin self-exam is very important for people with any risk factors of developing skin cancer, but routine skin self-exams are a good idea for everyone.

Keep in mind the ABCDEs of melanoma detection.

  • Asymmetry. Does one half of a mole look different from the other?
  • Border. Is the edge (border) of the mole ragged, notched, or blurred?
  • Color. Does the mole have a variety of hues or colors within the same lesion?
  • Diameter. Is the mole wider than 6mm or 1/4 inch?
  • Evolving. Does the mole or skin lesion look different from your other moles or has it changed in shape color, size or other trait?

If you see a mole or new spot on your skin that has any of the ABCDEs, immediately make an appointment to see your doctor.

LEARN MORE ABOUT THE ABCDEs OF SKIN CANCER DETECTION.

Risk Factors for Melanoma

Melanoma
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No one knows the exact causes of melanoma. Doctors can seldom explain why one person gets melanoma and another does not.

However, research has shown that people with certain risk factors are more likely than others to develop melanoma. Still, many people with melanoma have no known risk factors.

Studies have found the following risk factors for melanoma:

  • Dysplastic nevi: Dysplastic nevi are more likely than ordinary moles to become cancerous. Dysplastic nevi are common, and many people have a few of these abnormal moles.
  • Many (more than 50) ordinary moles: Having many moles increases the risk of developing melanoma.
  • Fair skin: Melanoma occurs more frequently in people who have fair skin that burns or freckles easily (these people also usually have red or blond hair and blue eyes) than in people with dark skin.
  • Personal history of melanoma or skin cancer: People who have been treated for melanoma have a high risk of a second melanoma. Some people develop more than two melanomas. People who had one or more of the common skin cancers (basal cell carcinoma or squamous cell carcinoma) are also at increased risk of melanoma.
  • Family history: Melanoma sometimes runs in families. Having two or more close relatives who have had this disease is a risk factor. When melanoma runs in a family, all family members should be checked regularly by a doctor.
  • 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.
  • Severe, blistering sunburns: People who have had at least one severe, blistering sunburn as a child or teenager are at increased risk of melanoma. 
  • Ultraviolet (UV) radiation: Experts believe that much of the worldwide increase in melanoma is related to an increase in the amount of time people spend in the sun. This disease is more common in people who live in sunny climates. Artificial sources of UV radiation, such as sunlamps and tanning booths, also can damage the skin and increase the risk of melanoma.

Stages of Melanoma

If the diagnosis is melanoma, the doctor needs to learn the extent, or stage, of the disease before planning treatment. Staging is a careful attempt to learn how thick the tumor is, how deeply the melanoma has invaded the skin, and whether melanoma cells have spread to nearby lymph nodes or other parts of the body.

The following stages are used to describe melanoma:

  • 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 I: Melanoma in stage I is thin and has not spread to nearby lymph nodes.
  • Stage II: The tumor is at least 1 millimeter thick and may be ulcerated; the melanoma cells have not spread to nearby lymph nodes.
  • Stage III: The melanoma cells have spread to nearby tissues.
  • Stage IV: The melanoma cells have spread to organs, lymph nodes, or skin far away from the original tumor.
  • Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may have come back in the original site or in another part of the body.

Treatment of Melanoma

Your doctor will describe treatment options for melanoma. Factors such as the stage and location of the disease and the person's general health will be taken into account when recommending a treatment plan.

Stage III or Stage IV melanoma is often referred to as "late-stage" or "advanced" melanoma. People with late-stage melanoma are often treated by a team of specialists. The team may include a dermatologist, surgeon, medical oncologist, radiation oncologist, and plastic surgeon.

Medications for Melanoma

The FDA has recently approved several new medications for the treatment of late-stage melanoma. These medications are not a cure, but they can extend the period that some people can stay in remission.

An individual's response to treatment with these medications varies signficantly and depends on several factors.

New medications for melanoma include:

  • Peginterferon alfa-2b. This form of interferon is approved for patients aged 18 and older who have stage III melanoma. Patients take this drug after undergoing surgery to remove lymph nodes that contain cancer. It is usually started within several weeks of surgery. Peginterferon helps the body to find and destroy stray melanoma cells not removed during surgery, which may delay the melanoma from returning.
  • Yervoy (ipilimumab). This medication administered via an IV is approved for patients ages 18 and older who have melanoma that is in stage III or stage IV and cannot be removed with surgery. Yervoy blocks a specific molecule, which may allow the patient’s body to recognize, target, and attack melanoma cells.
  • Zelboraf (Vemurafenib). This medication is approved for patients whose melanoma cells contain a specific mutation called the BRAF V600 mutation which is found in about 1/2 of cases of late-stage melanoma. Zelboraf targets the BRAF mutation, which may stop the cancer cells from continuing to grow uncontrollably and the cancer from getting worse.

Your doctor will consider many factors before prescribing one of these drugs.

Additional research is underway to develop newer therapies.

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© 2010 Vivacare. Last updated May 1, 2012.
Images courtesy of Gerald Goldberg, M.D.

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This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

From Your Doctor service powered by Vivacare.

Additional Resources

Overview
Melanoma (link to AAD)
Melanoma Overview (link to NIH)
Medications
Related Conditions
Prevention
Mole Map (PDF) (link to AAD)
Self Care
Support & Research Groups
Melanoma Research Foundation (link to Melanoma Research Foundation)
Clinical Trials
Clinical Trials for Skin Cancer - Melanoma (link to ClinicalTrials.gov)
En Espanol
Cancer de Piel Melanoma (link to NIH)
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