Topic Overview
What is melanoma?
Melanoma is a kind of
skin cancer. It isn't as common as other types of skin cancer, but it is the
most serious.
Melanoma can affect your skin only, or it may
spread to your organs and bones. As with other cancers, treatment for melanoma works best when the cancer is found early.
This topic is about melanoma that occurs in the skin. It doesn't cover melanoma that occurs in the eye or in any other part of the body besides the skin.
What causes melanoma?
You can get melanoma by
spending too much time in the sun. Too much sun exposure causes normal skin cells to become
abnormal. These abnormal cells quickly grow out of control and attack the
tissues around them.
You are at higher risk for melanoma if you have many abnormal, or atypical, moles. These moles may fade into the skin and have a flat part that is level with the skin. They may be smooth or slightly scaly, or they may look rough and "pebbly." Having these moles may also be a sign that melanoma runs in your family.
What are the symptoms?
The main sign of melanoma
is a change in a mole or other skin growth, such as a birthmark. Any change in
the shape,
size, or
color of a mole may be a sign of melanoma.
Melanoma may look like a flat, brown or black mole
that has uneven
edges. Melanomas usually have an irregular or
asymmetrical shape. This means that one half of the mole doesn't match the
other half. Melanoma moles or marks may be any size, but they are usually
6 mm (0.25 in.) or larger.
Melanoma may grow in a mole or birthmark that you already have or in unmarked skin. The mole or birthmark can be found anywhere on your
body. Most of the time, they are on the upper back in men and women and on the
legs of women.
How is melanoma diagnosed?
Your doctor will check
your skin to look for melanoma. If your doctor thinks that you have melanoma, he or
she will remove a sample of tissue from the area around the melanoma
(biopsy). Another doctor, called a
pathologist, will look at the tissue to check for
cancer cells.
If your biopsy shows melanoma, you may need to have
more tests to find out if it has spread to your
lymph nodes.
How is it treated?
The most common treatment is
surgery to remove the melanoma. That is all the treatment that you may need for
early-stage melanomas that have not spread to other parts of your body.
After surgery, your doctor will set up a schedule of frequent checkups that will happen less often as time goes on.
If your melanoma is very deep or
has spread to your lymph nodes, your doctor may talk with you about other treatment. You may need to take a
medicine called interferon, or you might need chemotherapy or radiation.
Can you prevent melanoma?
The best way to prevent
all kinds of skin cancer, including melanoma, is to protect yourself whenever
you are out in the sun.
- Try to stay out
of the sun during the middle of the day (from 10 a.m. to 4 p.m.).
- Wear protective clothes when you are outside, such as a hat that
shades your face, a long-sleeved shirt, and long pants.
- Use sunscreen every day. Your sunscreen should have an
SPF of least 15. Look for a sunscreen that protects
against both types of UV radiation in the sun's rays—UVA and
UVB.
- Use a higher SPF when you are at higher
elevations.
- Avoid sunbathing and tanning salons.
Check your skin every month for odd marks, moles, or
sores that will not heal. Check all of your skin, but pay extra attention to areas that get a lot of sun,
such as your hands, arms, and back. Ask your doctor to check your skin during
regular physical exams or at least once a year.
Frequently Asked Questions
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Learning about melanoma:
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Being diagnosed:
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Getting treatment:
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Ongoing concerns:
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Living with melanoma:
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End-of-life issues
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Cause
Melanoma is most often caused by too much exposure to the sun's UV rays. Examples include:1
- Having had blistering sunburns at any time of life.
- Getting intense
sun exposure every now and then.
Things that make getting melanoma more likely include your skin type, the color of your hair, and the color of your eyes. To learn more, see What Increases Your Risk.
Symptoms
Most melanomas start as a new skin growth on unmarked skin. The growth may change color, shape, or size. These types of changes are an early sign that the growth is melanoma. But melanoma can also develop in an existing mole or other mark on the skin.
Melanoma can grow
anywhere on the body. It most often occurs on the upper back of men and women and on
the legs in women. Less often, it can grow on the soles, palms, nail beds, or
mucous membranes that line body cavities such as the
mouth, the rectum, and the vagina.
On older people, the face is the most common
place for melanoma to grow. And in older men, the most common sites are the
neck, scalp, and ears.1
Signs of melanoma
The most important warning sign for
melanoma is any change in size,
shape, or color of a
mole or other skin growth, such as a birthmark. Watch
for changes that occur over a period of weeks to a month. The
ABCDE system tells you what changes to look for.
- A is for
asymmetry. One half of the mole or skin growth doesn't
match the other half.
- B is for
border irregularity. The edges are ragged, notched, or blurred.
- C
is for color. The color is not the same throughout the mole.
- D is for
diameter. The mole or skin growth is larger than
the
size of a pencil eraser.
- E is for evolution. There is a change in the size, shape,
symptoms (such as itching or tenderness), surface (especially bleeding), or
color of a mole.
Melanoma in an existing mole
Signs of melanoma in an existing mole include changes
in:
- Elevation, such as thickening or raising of a
previously flat mole.
- Surface, such as scaling, erosion, oozing,
bleeding, or crusting.
- Surrounding skin, such as redness, swelling,
or small new patches of color around a larger lesion (satellite
pigmentations).
- Sensation, such as itching, tingling,
burning, or pain.
- Consistency, such as softening or small pieces that break
off easily.
Many
other skin conditions (such as
seborrheic keratosis,
warts, and
basal cell cancer) have features similar to those of
melanoma.
Signs of melanoma that has spread
Symptoms of
melanoma that has spread (metastatic melanoma) may be vague. They include swollen
lymph nodes, especially in the armpit or
groin, and a colorless lump or thickening under the
skin.
What Happens
Melanoma develops when normal pigment-producing skin
cells called
melanocytes become abnormal, grow uncontrollably, and
invade surrounding tissues. Usually only one melanoma develops at a time.
Melanomas can begin in an existing
mole or other skin growth, but most start in unmarked
skin. Melanoma can be primary or metastatic.
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Primary melanoma
usually follows a predictable
pattern of growth through the
skin layers. Finding it early and having surgery to remove it can cure most
cases of primary melanoma. If it's not treated, most melanomas spread
to other parts of the body over time.
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Metastatic melanoma spreads through the
lymph system to nearby skin or lymph nodes or through
the bloodstream to other organs such as the brain or the liver. Metastatic
melanoma usually cannot be cured.
Experts talk about prognosis in terms of "5-year survival rates." The
5-year survival rate means the percentage of people who are still alive 5 years
or longer after their cancer was discovered. Remember that these are only
averages. Everyone's case is different, and these numbers don't necessarily
show what will happen to you. The estimated 5-year survival rate for melanoma
is:2
- 98% if cancer is found early and treated
before it has spread.
- 62% if the cancer has spread to close-by
tissue.
- 15% if the cancer has spread farther away, such as to the
liver, brain, or bones.
What Increases Your Risk
A risk factor for melanoma is something that increases your chance of getting this cancer. Having one or more of these risk factors can make it more likely that you will get melanoma. But it doesn't mean that you will definitely get it. And many people who get melanoma don't have any of these risk factors.
Risk factors for
melanoma include:1
- Too much exposure to
the sun's UV rays. This includes:
- Having had blistering sunburns at any time of life.
- Getting intense
sun exposure every now and then.
- Fair skin that doesn't tan and tends to sunburn or freckle, along with blue or green eyes or red or blond hair.
- Numerous moles and/or more than one
atypical mole.
- A large mole you had since
birth.
- A personal or family history of
melanoma.
- Changes in your genes, like the change that causes a skin disease called Xeroderma pigmentosum.
When To Call a Doctor
The most important warning sign
for
melanoma is a change in size, shape, or color of a
mole or other skin growth (such as a birthmark). Call
your doctor if you have:
- Any change in a mole, including size, shape,
color, soreness, or pain.
- A bleeding mole.
- A discolored
area under a fingernail or toenail not caused by an injury.
- A
general darkening of the skin unrelated to sun exposure.
Call your doctor immediately if you
have been diagnosed with melanoma and:
- You have trouble breathing or
swallowing.
- You cough up or spit up blood.
- You have blood in your vomit or bowel
movement.
- Your urine or bowel movement is black, and the blackness
isn't caused by taking iron or Pepto-Bismol.
Who to see
The following health professionals can
help diagnose melanoma:
If further treatment is needed, melanoma can be treated by a dermatologist, surgeon,
plastic or reconstructive surgeon, or
medical oncologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
To check for melanoma and whether or not it has spread, your doctor may:
Other techniques
may include total-body photography to look for changes in any mole and to
watch for new moles appearing in normal skin. A series of photos of the
suspicious lesions may be taken. Then the photos can be used as a baseline to
compare with follow-up photos.
Finding skin cancer early
- Do a skin self-exam once a month. Your partner or a close friend can help you
check places that are hard to see, such as your scalp
and back.
- Have your doctor check
any suspicious skin changes. Be sure you see your doctor at least once a year. You may need checkups more often if you have:
- Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to develop
melanoma. Your doctor may need to check you every 4 to
6 months.
- Increased
exposure to ultraviolet (UV)
radiation because of your job, hobbies, or outdoor activities.
- Abnormal moles called
atypical moles. These moles aren't
cancerous. But their presence is a warning of an inherited tendency to develop
melanoma.
Treatment Overview
Melanoma may be cured if it's found
and treated in its early stages when it affects only the skin. If melanoma has spread, it is much harder to treat.
How much and what type of treatment you need depends on the
stage.
Regular follow-up appointments are
important after you have been diagnosed with melanoma.
Your doctor will set up a regular schedule of checkups that will happen less often as time goes on.
Primary melanoma
If melanoma is
confined to the skin (primary melanoma), you will have surgery. The entire
melanoma is cut out, along with a border (margin) of normal-appearing skin. If the melanoma is thin and hasn't spread to surrounding tissues,
this may cure the melanoma.
To learn more, see Surgery.
Metastatic and recurrent melanoma
Melanoma can spread (metastasize) to other parts of the body, where it can cause tumors. When melanoma has spread to only one tumor in another part of the body, it sometimes can be successfully treated with surgery. But metastatic melanoma usually needs other treatments, too, such as chemotherapy, interferon, immunotherapy, or radiation therapy.
To learn more, see Medications.
Melanoma can come
back after treatment. This called recurrent melanoma. All the treatment mentioned above may be used, as well as:
- Hyperthermic isolated limb perfusion. If the melanoma is on your arm or leg, chemotherapy medicine may be added to a warm solution and injected into the bloodstream of that arm or leg. The flow of blood to and from that limb is stopped for a short time so the medicine can go right to the tumor.
- Medicines injected directly into the tumor.
- Lasers to destroy the tumor.
Metastatic and recurrent melanoma usually cannot be cured. Your doctors will try to control symptoms, reduce complications, and keep you comfortable.
Your doctor may recommend that you join a clinical trial if one is available in your area. Clinical trials may offer the best treatment option for people with metastatic cancer. Clinical trials study other treatments, such as combinations of chemotherapy, vaccines, and immunotherapies. They are also studying targeted therapy.
For more information about specific treatments, see:
Side effects of treatment
The side effects of treatment for melanoma include nausea, vomiting, fatigue, and pain. Your side effects will depend on which type of treatment you have. They may be mild enough that you can do things at home to manage them. To learn more about side effects and how you can treat them, see Home Treatment.
Your emotions
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly.
Some people find that it helps to talk about their feelings with their family and friends.
If your emotional reaction to cancer
interferes with your ability to make decisions about your health, it's
important to talk with your doctor. Your cancer treatment center may offer
psychological or financial services. You may also contact your local chapter of
the American Cancer Society to help you find a support group.
Supportive care
Your quality of life may be improved by having palliative care to manage your symptoms.
For some
people with advanced-stage cancer, a time comes when treatment to cure cancer no longer seems like a good
choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or
relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.
It can be hard to decide when to stop treatment to prolong your life and shift the focus to end-of-life care.
To learn about the different types of supportive care, see:
Prevention
To help prevent skin cancer:
- Protect your skin.
This includes staying out of the sun
during the midday hours and using sunscreen.
Skin Cancer: Protecting Your Skin
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Examine your skin
regularly, and have
your doctor check your skin during all other health exams, or at least once a
year.
For more information, see:
Home Treatment
Home treatment can help you manage any side effects that your treatment might cause. If your doctor gives you instructions or medicines to
treat these side effects, be sure to follow them. In general, healthy habits such
as eating a balanced diet and getting enough sleep and exercise may help
control your symptoms.
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Home treatment for nausea or vomiting
includes watching for and treating early signs of
dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.
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Home treatment for diarrhea
includes
resting your stomach and watching for signs of dehydration. Check with your
doctor before using any nonprescription medicines for your
diarrhea.
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Home treatment for constipation
includes gentle exercise along with getting enough fluids and having a diet that
is high in fruits, vegetables, and fiber. Check with your doctor before using a
laxative for your constipation.
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Home treatment for fatigue
includes making sure you get extra rest if you are receiving
chemotherapy or
radiation therapy. Let your symptoms be your guide.
You may be able to stay with your usual routine and just get some extra sleep.
Fatigue is often worse at the end of treatment or just after treatment is
completed.
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Home treatment for sleep problems
includes going to bed at the same time every night and getting exercise during the day.
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Home treatment for pain
includes using heat and cold packs.
Stress, hair loss, and body image
- The diagnosis of melanoma and the need for treatment can be very stressful. You may be able to reduce your stress by expressing your feelings to others. Learning relaxation techniques may also help reduce your
stress.
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Hair loss can be emotionally
distressing. Not all chemotherapy medicines cause hair loss. And some people
have only mild thinning that is noticeable only to them. Talk to your doctor
about whether hair loss is an expected side effect with the medicines you will
receive.
- Your feelings about your body may change following a
diagnosis of melanoma and the need for treatment.
Adapt to your body image changes by
talking openly about your concerns with your partner and discussing your
feelings with your doctor. Your doctor may also be able to refer you to groups
that can offer more support and information.
Medications
Medicines for melanoma include:
- Chemotherapy with single or several medicines, such as dacarbazine or temozolomide.
- Immunotherapy with interferon or interleukin-2.
Chemotherapy
Chemotherapy used to treat melanoma may be given as an outpatient treatment. But sometimes people need a short hospital stay.
Medicines used for chemotherapy may be taken by mouth or injected into your bloodstream so they can travel throughout your body. If the melanoma is on an arm or a leg, chemotherapy medicines may be added to a warm solution that is injected into the bloodstream of that limb. The flow of blood to and from that limb is stopped for a short time so the medicine can go right to the tumor. This is called hyperthermic isolated limb perfusion.
Surgery
Surgery is the most common treatment for melanoma. Lymph nodes may be removed at the same time to check them for cancer. Surgery also may be done to remove lymph nodes that have cancer or to remove melanoma that may have spread to other parts of the body.
Surgery choices
The most common types of surgery used to treat melanoma
include:
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Local excision. This surgery takes out the melanoma and a little of the tissue around it.
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Wide local excision. This surgery removes more of the tissue around the melanoma. Lymph nodes may also be removed during this surgery.
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Lymph node dissection (lymphadenectomy). This is
surgery to remove lymph nodes to see if they have cancer cells. Or this may be done to remove lymph nodes that are cancerous.
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Sentinel lymph node biopsy. This surgery removes the first lymph node that the cancer may have spread to from the tumor. If this lymph node doesn't have any cancer cells, then you may not need to have more lymph nodes removed.
After removal of a primary
melanoma, you may need a skin
graft or other reconstructive surgery for cosmetic reasons or to restore function. This is most likely if the
melanoma was large or was a late-stage tumor.
Other Treatment
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
Other Places To Get Help
Organizations
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American Academy of Dermatology
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| P.O. Box 4014 |
| Schaumburg, IL 60168 |
| Phone: |
1-866-503-SKIN (1-866-503-7546) toll-free
(847) 240-1280 |
| Fax: |
(847) 240-1859 |
| Email: |
MRC@aad.org |
| Web Address: |
www.aad.org |
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The American Academy of Dermatology provides information
about the care of skin, hair, and nails. You can locate a dermatologist in your
area by using their "Find a Dermatologist" tool at www.aad.org/find-a-derm.
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American Cancer Society (ACS)
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| Phone: |
1-800-ACS-2345 (1-800-227-2345) |
| TDD: |
1-866-228-4327 toll-free |
| Web Address: |
www.cancer.org |
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The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free numbers have information about services and activities
in local areas and can provide referrals to local ACS divisions.
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American Melanoma Foundation
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| 12395 El Camino Real |
| Suite 117 |
| San Diego, CA 92130 |
| Phone: |
(619) 448-0991 |
| Web Address: |
http://www.melanomafoundation.org |
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The American Melanoma Foundation (AMF) is a charitable, nonprofit
organization that funds research on melanoma. AMF also provides education to
the public on melanoma prevention and supports melanoma patients and their
families.
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National Cancer Institute (NCI)
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| 6116 Executive Boulevard |
| Suite 300 |
| Bethesda, MD 20892-8322 |
| Phone: |
1-800-4-CANCER (1-800-422-6237) |
| Web Address: |
www.cancer.gov (or
https://livehelp.cancer.gov/app/chat/chat_launch for live help
online) |
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The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
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Skin Cancer Foundation
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| 149 Madison Avenue |
| Suite 901 |
| New York, NY 10016 |
| Phone: |
1-800-SKIN-490 (1-800-754-6490) |
| Email: |
info@skincancer.org |
| Web Address: |
http://www.skincancer.org |
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The foundation is a nonprofit organization that provides
information on all aspects of skin cancer. It also publishes journals with
nontechnical articles on skin cancer.
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References
Citations
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Paek SC, et al. (2008). Cutaneous melanoma. In K Wolff
et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 1134–1157. New York: McGraw-Hill Medical.
-
American Cancer Society (2010). Cancer Facts and Figures 2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf.
Other Works Consulted
- Busam KJ, et al. (2005). Melanoma diagnosis by
confocal microscopy: Promise and pitfalls. Journal of Investigative Dermatology, 125(3): vii–xi.
- Halpern AC, Myskowski PL (2009). Malignant cutaneous tumors. In EG Nabel, ed., ACP Medicine, section 2, chap. 10. Hamilton, ON: BC Decker.
- Larkin J, Gore M (2008). Malignant melanoma
(metastatic), search date September 2007. Online version of BMJ Clinical Evidence: http://www.clincalevidence.com.
- Markowitz O, Rigel DS (2010). Malignant melanoma. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, pp. 424–428. Edinburgh: Saunders Elsevier.
- Marsden JR, et al. (2010). Revised U.K. Guidelines for the management of cutaneous melanoma 2010. British Journal of Dermatology, 163(2): 238–256.
- National Cancer Institute (2010). Melanoma PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/patient.
- National Cancer Institute (2010). Skin Cancer PDQ: Prevention – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/prevention/skin/HealthProfessional.
- National Cancer Institute (2010). Skin Cancer PDQ: Prevention – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/prevention/skin/patient.
- National Comprehensive Cancer Network (2010). Melanoma. Clinical Practice Guidelines in Oncology, version 2. Available online: http://www.nccn.org/professionals/physician_gls/PDF/melanoma.pdf.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
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Kathleen Romito, MD - Family Medicine |
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Specialist Medical Reviewer
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Alexander H. Murray, MD, FRCPC - Dermatology |
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Last Revised
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July 27, 2012 |
