Melanoma is a cancer of cells that make the skin pigment (color). It usually starts in existing moles. It may spread to other parts of the body if it isn’t treated.
You can help find melanoma in its early stages by checking your skin regularly and getting it checked by a doctor. Learn to recognize the ABCDEs of melanoma:
Early signs and symptoms
Most often, melanoma begins as a new spot or growth that appears on the skin. It can also start on an existing mole, usually one that’s been there for a while. It’s important to see a doctor right away if you find a new spot or growth that seems unusual. Also talk to your doctor if an existing mole changes in any way. The earlier melanoma is caught, the more likely it is to be treated successfully.
Melanomas are most common on sun-exposed areas of the body, especially in men’s chests and backs and women’s legs. But they can occur anywhere on the body, including the face, neck, hands, and feet. Rarely, a melanoma can begin in the eye (intraocular melanoma).
People who have many moles or a family history of melanoma may have an increased risk of developing the disease. People with a weak immune system have an even higher risk, such as those who’ve had an organ transplant or have diseases that suppress the immune system like AIDS. Other risk factors include having a lot of blistering sunburns as a child or teenager, having a lot of freckles or dark spots on the skin, and using tanning beds. The most serious risk factor for melanoma is having more than one melanoma on or near the body.
Diagnosis
Melanomas grow deeper into the skin and can spread to nearby tissues before being detected. This is why it is important to check your own skin regularly with a mirror and have annual checks by a doctor who specialises in dermatology (the diagnosis of melanoma and other skin cancers).
To diagnose melanoma, the doctor will examine the area with a handheld magnifying instrument called a dermascope. They will consider the ABCDE rule and also the thickness of the melanoma, as well as its margins (the healthy tissue around it). They may also feel the lymph nodes near the site of the melanoma to see if they are enlarged, as melanoma can spread via these vessels.
The doctor might suggest a surgical biopsy, where they remove a small amount of the suspicious growth. They will usually numb the area with a local anaesthetic before this, to prevent any pain. The cells will then be sent to a laboratory for testing to confirm the diagnosis.
Other tests can help to find out if the melanoma has spread, including a blood test that measures an enzyme called lactate dehydrogenase (LDH). These tests are not used in all cases, and the results of the biopsy and tumour marker are needed to determine the stage of the melanoma. Your doctor may also recommend a CT scan or an MRI to check the area for signs of spread, or to help plan your treatment.
Treatment
Depending on your cancer’s stage and whether it has spread, treatment options include surgery, chemotherapy, immunotherapy and radiation. Your doctor will advise you on the best treatment for your melanoma.
If the melanoma is thinner, surgery to remove it may be all that’s needed. If it’s thicker, or if your GP thinks it might have spread, further tests will be done to find out if the cancer has reached nearby lymph nodes (a procedure called sentinel node biopsy). If it has, surgery may be combined with chemotherapy or radiation therapy.
Other treatment options include the drugs dacarbazine (DTIC; available as a generic drug) and temozolomide (Memodar). These drugs are given in a series of cycles over a set period of time, usually 6 months or more. They have a high chance of making the melanoma shrink, but they also have many side effects. These include fatigue, risk of infection, nausea and vomiting, diarrhea, changes in nails and hair, loss of appetite and weight, tiredness, headache and chills, and flu-like symptoms.
If the melanoma has spread to the brain, doctors use stereotactic radiosurgery (also known as Gamma Knife). This uses hundreds of beams that focus on the tumor, sparing normal tissue. Other therapies, including biologic and targeted treatments, are being investigated in clinical trials. These aim to boost the body’s own natural defenses against cancer and to target specific mutations in cancer cells.
Prevention
Melanoma is a type of skin cancer that develops in cells called melanocytes. It occurs when the DNA in these cells becomes damaged, usually by ultraviolet (UV) radiation from sunlight or UV rays from tanning beds. Most melanomas are caused by gene changes that occur over the course of a person’s lifetime and are not inherited.
People with fair skin, blond or red hair and light eyes are more likely to get melanoma because their cells don’t produce much natural protection from UV radiation. However, melanoma can also occur in people with darker complexions. Having many moles and having atypical or changing (dysplastic) moles on the skin increases a person’s risk of developing melanoma.
Although people with these risk factors are at higher risk, most do not have melanoma. Risk factors are only part of the picture; you can’t predict who will or will not get melanoma.
Several tests are used to find out whether melanoma has spread within the skin or to other parts of the body. This process is called staging. Fine needle aspiration biopsy: This test uses a thin needle and syringe to remove a small amount of fluid or tissue from a suspicious area. A specialized doctor, called a dermatopathologist, examines the tissue or fluid for signs of melanoma and sends a report to your primary physician.