Overview
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.
Melanocytes, which are skin cells, are the source of melanoma. Melanin, a dark pigment that gives skin its color, is produced by these cells. However, some melanomas are pink, red, purple, or skin-colored. Melanomas are often black or brown in hue.
The majority of melanomas start in normal skin, however around 30% start in moles that already exist. Given that the majority of melanomas don’t begin as moles, it is crucial to remain alert to changes in your skin. Your skin’s propensity to acquire melanoma may, however, be predicted in part by the number of moles you have. Knowing if you belong to a population with a higher risk of acquiring melanoma skin cancer is crucial. Due to melanomas’ rapid pace of development, delaying treatment might occasionally mean the difference between life and death. Since melanomas have a 99% cure rate if identified in the earliest stages, knowing your risk might help you be especially alert in detecting changes in your skin and obtaining skin checks. Early diagnosis is crucial as
How common is melanoma?
Though it only accounts for around 1% of all skin malignancies, melanoma is the leading cause of mortality from skin cancer. It is one of the most prevalent malignancies in persons under the age of 30, particularly among young women.
Over the past 30 years, melanoma incidence has substantially grown. It is commonly acknowledged that one of the primary causes of this sharp increase in melanoma occurrences is rising UV exposure levels.
Signs
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.
Symptoms
The majority of medical professionals concur that excessive sun exposure, especially sunburns while you are young, is a significant risk factor for melanoma. According to statistics, solar ultraviolet (UV) rays are the primary cause of 86% of melanomas. What causes skin cancer in the sun? UV radiation can alter certain genes that control how cells grow and divide by damaging a cell’s DNA. When your skin’s DNA is harmed and those cells begin to divide, issues might arise.
The World Health Organization has classified UV radiation from tanning beds as a carcinogen, or substance that causes cancer, since it raises the risk of melanoma. Over 6,000 melanoma incidences are thought to be linked to tanning bed usage each year in the US.
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.
Hidden melanomas
Melanomas can also appear on parts of your body that receive little or no sun exposure, such the gaps between your toes, your palms and soles, your scalp, or your genitalia. Because they appear in locations that most people wouldn’t think to inspect, they are frequently called hidden melanomas. People with darker skin are more prone to develop melanoma in a concealed location.
Hidden melanomas include:
- Melanoma under a nail. Acral-lentiginous melanoma is a rare form of melanoma that can occur under a fingernail or toenail. It can also be found on the palms of the hands or the soles of the feet. It’s more common in people of Asian descent, black people and in others with dark skin pigment.
- Melanoma in the mouth, digestive tract, urinary tract or vagina. Mucosal melanoma develops in the mucous membrane that lines the nose, mouth, esophagus, anus, urinary tract and vagina. Mucosal melanomas are especially difficult to detect because they can easily be mistaken for other far more common conditions.
- Melanoma in the eye. Eye melanoma, also called ocular melanoma, most often occurs in the uvea — the layer beneath the white of the eye (sclera). An eye melanoma may cause vision changes and may be diagnosed during an eye exam.
Causes
Melanoma develops when the melanin-producing cells (melanocytes) that give your skin color malfunction.
A healthy new cell will push an older cell toward the surface of your skin, where it will die and eventually fall off. This is how skin cells normally develop. However, when certain cells experience DNA damage, new cells may start to proliferate rapidly and may eventually group together to create a mass of malignant cells.
Just what damages DNA in skin cells and how this leads to melanoma isn’t clear. It’s likely that a combination of factors, including environmental and genetic factors, causes melanoma. Still, doctors believe exposure to ultraviolet (UV) radiation from the sun and from tanning lamps and beds is the leading cause of melanoma.
UV light doesn’t cause all melanomas, especially those that occur in places on your body that don’t receive exposure to sunlight. This indicates that other factors may contribute to your risk of melanoma.
Risk factors
Factors that may increase your risk of melanoma include:
- Fair skin. Having less pigment (melanin) in your skin means you have less protection from damaging UV radiation. If you have blond or red hair, light-colored eyes, and freckle or sunburn easily, you’re more likely to develop melanoma than is someone with a darker complexion. But melanoma can develop in people with darker complexions, including Hispanic people and black people.
- A history of sunburn. One or more severe, blistering sunburns can increase your risk of melanoma.
- Excessive ultraviolet (UV) light exposure. Exposure to UV radiation, which comes from the sun and from tanning lights and beds, can increase the risk of skin cancer, including melanoma.
- Living closer to the equator or at a higher elevation. People living closer to the earth’s equator, where the sun’s rays are more direct, experience higher amounts of UV radiation than do those living farther north or south. In addition, if you live at a high elevation, you’re exposed to more UV radiation.
- Having many moles or unusual moles. Having more than 50 ordinary moles on your body indicates an increased risk of melanoma. Also, having an unusual type of mole increases the risk of melanoma. Known medically as dysplastic nevi, these tend to be larger than normal moles and have irregular borders and a mixture of colors.
- A family history of melanoma. If a close relative — such as a parent, child or sibling — has had melanoma, you have a greater chance of developing a melanoma, too.
- Weakened immune system. People with weakened immune systems have an increased risk of melanoma and other skin cancers. Your immune system may be impaired if you take medicine to suppress the immune system, such as after an organ transplant, or if you have a disease that impairs the immune system, such as AIDS.
Diagnosis
Your doctor could remove any suspicious-looking moles or other spots from you and examine them under a microscope to see whether they contain cancer cells. It’s known as a biopsy.
The next step is to establish if the melanoma has spread when your doctor receives the skin biopsy findings indicating evidence of melanoma cells. Staging describes this. Once identified, melanoma will be classified according to a number of criteria, including the extent of its spread and how it appears under a microscope. The most crucial factor in outcome prediction is tumor thickness.
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.
Staging of Localized Melanoma Based on Thickness and Ulceration
| Stage | Description |
|---|---|
| 0 | Intraepithelial or in situ melanoma |
| IA | ≤ 0.8 mm with no ulceration |
| IB | ≤ 0.8–1 mm with ulceration0.8–2 mm with no ulceration |
| IIA | 1.01–2 mm with ulceration2.01–4 mm with no ulceration |
| IIB | 2.01–4 mm with ulceration≥ 4 mm with no ulceration |
| IIC | > 4 mm with ulceration |
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.
Treatment
The size and stage of the tumour, your general health, and your personal preferences will all influence the optimal course of therapy for your melanoma.
Treatment for small melanomas
Surgery to remove the melanoma is frequently used as treatment for early-stage melanomas. A very thin melanoma could be completely eliminated during the biopsy and not need any additional care. A border of healthy skin and a layer of tissue beneath the skin will also be removed by your surgeon if necessary. It’s possible that this is the sole therapy required for persons with early-stage melanomas.
Treating melanomas that have spread beyond the skin
If melanoma has spread beyond the skin, treatment options may include:
- Surgery to remove affected lymph nodes. If melanoma has spread to nearby lymph nodes, your surgeon may remove the affected nodes. Additional treatments before or after surgery also may be recommended.
- Immunotherapy. Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body’s disease-fighting immune system might not attack cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.Immunotherapy is often recommended after surgery for melanoma that has spread to the lymph nodes or to other areas of the body. When melanoma can’t be removed completely with surgery, immunotherapy treatments might be injected directly into the melanoma.
- Targeted therapy. Targeted drug treatments focus on specific weaknesses present within cancer cells. By targeting these weaknesses, targeted drug treatments can cause cancer cells to die. Cells from your melanoma may be tested to see if targeted therapy is likely to be effective against your cancer.For melanoma, targeted therapy might be recommended if the cancer has spread to your lymph nodes or to other areas of your body.
- Radiation therapy. This treatment uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. Radiation therapy may be directed to the lymph nodes if the melanoma has spread there. Radiation therapy can also be used to treat melanomas that can’t be removed completely with surgery.For melanoma that spreads to other areas of the body, radiation therapy can help relieve symptoms.
- Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Chemotherapy can be given intravenously, in pill form or both so that it travels throughout your body.Chemotherapy can also be given in a vein in your arm or leg in a procedure called isolated limb perfusion. During this procedure, blood in your arm or leg isn’t allowed to travel to other areas of your body for a short time so that the chemotherapy drugs travel directly to the area around the melanoma and don’t affect other parts of your body.
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.
Prevention
You can reduce your risk of melanoma and other types of skin cancer if you:
- Avoid the sun during the middle of the day. For many people in North America, the sun’s rays are strongest between about 10 a.m. and 4 p.m. Schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy.You absorb UV radiation year-round, and clouds offer little protection from damaging rays. Avoiding the sun at its strongest helps you avoid the sunburns and suntans that cause skin damage and increase your risk of developing skin cancer. Sun exposure accumulated over time also may cause skin cancer.
- Wear sunscreen year-round. Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously, and reapply every two hours — or more often if you’re swimming or perspiring.
- Wear protective clothing. Cover your skin with dark, tightly woven clothing that covers your arms and legs, and a broad-brimmed hat, which provides more protection than does a baseball cap or visor.Some companies also sell protective clothing. A dermatologist can recommend an appropriate brand. Don’t forget sunglasses. Look for those that block both types of UV radiation — UVA and UVB rays.
- Avoid tanning lamps and beds. Tanning lamps and beds emit UV rays and can increase your risk of skin cancer.
- Become familiar with your skin so that you’ll notice changes. Examine your skin often for new skin growths or changes in existing moles, freckles, bumps and birthmarks. With the help of mirrors, check your face, neck, ears and scalp.Examine your chest and trunk and the tops and undersides of your arms and hands. Examine both the front and back of your legs and your feet, including the soles and the spaces between your toes. Also check your genital area and between your buttocks.