Melanoma
Melanoma is a type of skin cancer that begins in melanocytes, the skin cells that produce melanin, which gives skin its color. It is also called malignant melanoma and cutaneous melanoma. Exposure to ultraviolet (UV) rays from the sun is a major cause, but with early detection and treatment, the survival rate is extremely high.
Overview
Melanoma is much less common than other types of skin cancers, like squamous cell carcinoma and basal cell carcinoma. If not detected and treated early, melanoma can be dangerous because it’s much more likely to spread to other parts of the body.
A melanoma typically presents as looking like a mole—in fact, an existing mole can become a melanoma. They can develop anywhere, but they typically start on the neck and face, on the trunk chest and back in men, and on the legs in women. They can also form in other parts of your body, like the eyes, mouth, genitals and anal area, but these are much less common than melanoma of the skin.
Most melanoma cells still make melanin, so melanoma tumors typically present as brown or black. Some melanomas do not make melanin, so they can appear pink, tan or even white.
Symptoms of melanoma
The most important warning sign of melanoma is a new spot on the skin, or a spot that is changing in size, shape or color. You might think the spot is just a mole, so you can use the ABCDE rule to look for the signs of melanoma:
- A – Asymmetry. One half of a mole or birthmark does not match the other.
- B – Border. The edges are irregular, ragged, notched or blurred.
- C – Color. The color is not the same all over and may include different shades of brown or black, or sometimes with patches of pink, red, white or blue.
- D – Diameter. The spot is larger than 6 millimeters across, although melanomas can sometimes be smaller than this.
- E – Evolving. The mole is changing in size, shape or color.
Some melanomas don’t fit these rules. It’s important to tell your doctor about any changes or new spots on the skin, or growths that look different from the rest of your moles.
Other melanoma warning signs
- A sore that doesn’t heal.
- Spread of pigment from the border of a spot into surrounding skin.
- Redness or a new swelling beyond the border of the mole.
- Change in sensation, such as itchiness, tenderness or pain.
- Change in the surface of a mole, like scaliness, oozing, bleeding or the appearance of a lump or bump.
- The ugly duckling sign—a spot that looks different from all of the other spots on your skin, even though it may still be flesh-colored.
Risk factors
These can make a person more likely to develop melanoma:
- UV light exposure. Sunlight is the main source, and tanning beds and sun lamps are also sources.
- Moles. A mole is actually a benign (non-cancerous) pigmented tumor.
- Having many moles. Most moles will never cause any problems, but someone who has many moles is more likely to develop melanoma.
- Atypical moles (dysplastic nevi). These moles look like normal moles but also have some features of melanoma.
- Dysplastic nevus syndrome (atypical mole syndrome). People with this inherited condition have many dysplastic nevi and have a very high lifetime risk of melanoma, so they need to have very thorough, regular skin exams by a dermatologist.
- Congenital melanocytic nevi. Moles present at birth.
- Fair skin, freckling and light hair. The risk of melanoma is much higher for whites than for African Americans.
- Family history of melanoma.
- Personal history of melanoma or other skin cancers.
- Having a weakened immune system.
- Being older. Melanoma is more likely to occur in older people, but it is also found in younger people.
- Being male.
- Xeroderma pigmentosum. A rare, inherited condition that affects skin cells’ ability to repair damage to their DNA.
Questions and answers about melanoma (FAQs)
How serious is melanoma and skin cancer?
Very. If left untreated, it can spread and cause death. However, treatment is typically very effective and can cure skin cancer.
What does melanoma look like at the beginning?
The first sign of melanoma is usually a change in the shape, look, color or feel of an existing mole
How long does it take for melanoma to spread?
Not long. It can spread quickly—in as little as six weeks, it can spread and become life-threatening.
Can skin cancer go away on its own?
No, skin cancer—like all forms of cancer—requires proper treatment.
Diagnosis of melanoma
Because no two people develop skin cancer in the same way, we offer a wide array of resources for proper evaluation of your situation—and we use that information to create a personalized plan to fit your specific needs.
Once a cancer has been diagnosed, our specialists need to know where it may have spread. This is the “stage” of the cancer. The lower the number, the less it has spread. Knowing the stage allows us to determine the best possible treatment plan for you.
We may use any combination of these tests and procedures to diagnose and stage skin cancer:
- Biopsy. Removes all or part of the abnormal-looking skin growth for viewing under a microscope by an expert skin pathologist to check for signs of cancer.
- CT scan (computed tomography). Uses a type of X-ray to create detailed, highly accurate, cross-sectional images to establish staging.
- Dermoscopy. Uses a drop of mineral oil on the lesion to reduce light reflection, make the skin more translucent, and assist in viewing skin lesions to accurately distinguish between suspicious moles and other pigmented lesions.
- Epiluminescence microscopy. Allows viewing of a lesion down to the dermo-epidermal junction—the areas where melanomas usually develop—that’s not visible to the naked eye.
- Excisional biopsy. Uses a scalpel to remove the entire growth.
- Mole mapping. Uses a full-body photograph and digital analysis to identify mole locations and different features as a way to help determine which moles need to be removed; also used to detect new moles and subtle changes in existing moles between visits.
- Magnetic resonance imaging (MRI) scan. Like CT scans, MRI scans show detailed images of soft tissues in the body.
- Positron emission tomography (PET) scan. A PET scan can look for possible areas of cancer spread in all areas of the body at once.
- Punch biopsy. Uses a special instrument called a punch to remove a circle of tissue from the abnormal-looking growth.
- Sentinel lymph node biopsy. A surgical procedure used to determine whether cancer has spread into the lymphatic system
- Skin examination. Uses a visual check of the skin for bumps or spots that look abnormal in color, size, shape or texture.
Melanoma staging
UCHealth follows the the American Joint Committee on Cancer (AJCC) TNM system for staging melanoma, which is based on three key pieces of information:
- The extent of the primary tumor (T). Includes tumor thickness and ulceration, the breakdown of the skin over the melanoma.
- The spread to nearby lymph nodes (N).
- The spread (metastasis) to distant sites (M).
The table below is a simplified version of the most recent TNM system, effective as of 2018. Melanoma staging can be very complex, so if you have any questions about the stage of your cancer or what it means, ask your doctor to explain it to you in a way you understand.
| AJCC Stage | Melanoma Stage Description |
|---|---|
| 0 | The cancer is confined to the epidermis, the outermost skin layer (Tis). It has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). This stage is also known as melanoma in situ. |
| I | The tumor is no more than 2mm (2/25 of an inch) thick and might or might not be ulcerated (T1 or T2a). The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0) |
| II | The tumor is more than 1 mm thick (T2b or T3) and may be thicker than 4 mm (T4). It might or might not be ulcerated. The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0). |
| IIIA | The tumor is no more than 2 mm thick and might or might not be ulcerated (T1 or T2a). The cancer has spread to 1 to 3 nearby lymph nodes, but it is so small that it is only seen under the microscope (N1a or N2a). It has not spread to distant parts of the body (M0). |
| IIIB | There is no sign of the primary tumor (T0) AND: The cancer has spread to only one nearby lymph node (N1b) OR It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor (without reaching the nearby lymph nodes) (N1c) It has not spread to distant parts of the body (M0). |
| OR | |
| The tumor is no more than 4 mm thick and might or might not be ulcerated (T1, T2, or T3a) AND: The cancer has spread to only one nearby lymph node (N1a or N1b) OR It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor (without reaching the nearby lymph nodes) (N1c) OR It has spread to 2 or 3 nearby lymph nodes (N2a or N2b) It has not spread to distant parts of the body (M0). | |
| IIIC | There is no sign of the primary tumor (T0) AND: The cancer has spread to 2 or more nearby lymph nodes, at least one of which could be seen or felt (N2b or N3b) OR It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor, and it has reached the nearby lymph nodes (N2c or N3c) OR It has spread to nearby lymph nodes that are clumped together (N3b or N3c) It has not spread to distant parts of the body (M0). |
| OR | |
| The tumor is no more than 4 mm thick, and might or might not be ulcerated (T1, T2, or T3a) AND: The cancer has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor, and it has reached nearby lymph nodes (N2c or N3c) OR The cancer has spread to 4 or more nearby lymph nodes (N3a or N3b), or it has spread to nearby lymph nodes that are clumped together (N3b or N3c) It has not spread to distant parts of the body (M0). | |
| OR | |
| The tumor is more than 2 mm but no more than 4 mm thick and is ulcerated (T3b) OR it is thicker than 4 mm but is not ulcerated (T4a). The cancer has spread to one or more nearby lymph nodes AND/OR it has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor (N1 or higher). It has not spread to distant parts of the body. | |
| OR | |
| The tumor is thicker than 4 mm and is ulcerated (T4b) AND: The cancer has spread to 1 to 3 nearby lymph nodes, which are not clumped together (N1a/b or N2a/b) OR It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor, and it might (N2c) or might not (N1c) have reached 1 nearby lymph node) It has not spread to distant parts of the body (M0). | |
| IIID | The tumor is thicker than 4 mm and is ulcerated (T4b) AND: The cancer has spread to 4 or more nearby lymph nodes (N3a or N3b) OR It has spread to nearby lymph nodes that are clumped together (N3b) It has spread to very small areas of nearby skin (satellite tumors) or to skin lymphatic channels around the tumor, AND it has spread to at least 2 nearby lymph nodes, or to lymph nodes that are clumped together (N3c) OR It has not spread to distant parts of the body (M0). |
| IV | The tumor can be any thickness and might or might not be ulcerated(any T). The cancer might or might not have spread to nearby lymphnodes (any N). It has spread to distant lymph nodes or to organs such as the lungs, liver or brain (M0). |
Source: American Cancer Society
Treatment and recovery
Your medical team will work with you to create the best treatment plan for your unique case and recovery. We may use any combination of surgery, chemotherapy, radiation, or new immunotherapies to treat or control your melanoma:
Surgery
Depending on location and severity of the skin cancer, surgery may take one of several forms for removing the tumor and some of the surrounding normal tissue to make sure all cancer cells are eliminated. Because cancer can spread through the lymphatic system, lymph nodes near the tumor also may be removed.
- Wide excision with oncologically appropriate margins. Removes both the tumor and some surrounding normal skin, typically at least 3 cm.
Immunotherapy
Immunotherapy uses medication to stimulate your immune system so it can do a better job of targeting and destroying cancer cells.
Radiation therapy
Radiation therapy or radiotherapy uses X-rays and other types of medical radiation aimed at specific parts of the body. The radiation kills cancer cells, prevents cancer cells from developing or recurring, and improves many of cancer’s symptoms. For certain cancers, radiation therapy is combined with chemotherapy and called chemo-radiotherapy.
Sentinel node biopsy
Sentinel node biopsy is a surgical procedure that helps show whether cancer has spread from the primary tumor into the lymphatic system. It involves a surgeon injecting a tracer material that helps them locate the sentinel nodes during surgery. The sentinel nodes are then removed and sent to a laboratory for analysis.
Lymph node dissection
Also called a lymphadenectomy, a lymph node dissection involves the removal of an area of lymph nodes that have cancer. Other lymph nodes may also be removed to prevent cancer from spreading there.
Types of melanomas
Superficial spreading melanoma. About 70% of all cases.
Lentigo maligna. Occurs most often in the elderly on chronically sun-exposed skin on the face, ears, arms and upper trunk.
Acral lentiginous melanoma. Presents as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands.
Nodular melanoma. Usually invasive at diagnosis, appearing as a black bump.
Desmoplastic melanoma. Presents as a slowly enlargening area of thickened skin, sometimes seen as ill-defined scar-like lesions.
Causes
We know that UV rays are a major cause of melanoma, as they can cause genetic mutations that turn cells into cancer. There are other risk factors to watch for as well.
Acquired gene mutations. Some genetic changes occur over a person’s lifetime, and are not inherited. We know that UV rays can damage DNA in skin cells, changing how they grow and divide. Most UV rays come from sunlight, but some can come from man-made sources such as tanning beds. The most common change in melanoma cells is a mutation in the BRAF oncogene, which is found in about half of all melanomas. Some melanomas occur in parts of the body that are rarely exposed to sunlight, which have different gene changes.
Inherited gene mutations. Sometimes people do inherit gene changes that raise their risk of melanoma, such as those with xeroderma pigmentosum (XP).
Five-year melanoma of the skin cancer survival rates
Number of Patients Diagnosed – UCHealth 1,196 – State of Colorado – 3,921
Number of Patients Surviving – UCHealth 960 – State of Colorado – 3,000
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)
Five-year skin cancer survival rates
Number of Patients Diagnosed – UCHealth 1,264 – State of Colorado – 4,209
Number of Patients Surviving – UCHealth 1,024 – State of Colorado – 3,199
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)
Five-year other skin cancer survival rates
Number of Patients Diagnosed – UCHealth 68 – State of Colorado – 288
Number of Patients Surviving – UCHealth 53 – State of Colorado – 198
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)
References
National Cancer Institute (NCI). Skin Cancer (Including Melanoma) (https://www.cancer.gov/types/skin)
American Academy of Dermatology Association. Skin cancer types: Melanoma (https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma)
MedlinePlus: National Library of Medicine. Melanoma (https://medlineplus.gov/melanoma.html)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Malignant Melanoma (https://www.ncbi.nlm.nih.gov/books/NBK470409/)