Skin Cancer, Melanoma
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?
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
Learning about melanoma:
Living with melanoma:
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|Skin Cancer: Protecting Your Skin|
- 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.
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.
Signs of melanoma that has spread
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.
- 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.
- 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:
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:
- Do a physical exam of your skin.
- Do a skin biopsy. Your doctor will take a sample of your skin and have it tested for melanoma.
- Check your lymph nodes to see if they are larger than normal. This may be followed by a sentinel lymph node biopsy to see if the melanoma has spread to your lymph system.
- Use imaging tests to see if the cancer has spread to other parts of your body, such as the lungs, brain, or liver. These tests include emission tomography (PET scan), computed tomography (CT scan), and magnetic resonance imaging (MRI).
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.
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.
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:
- Melanoma Treatment (PDQ): Health Professional Information
- Melanoma Treatment (PDQ): Patient Information
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.
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.
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:
To help prevent skin cancer:
- Protect your skin. This includes staying out of the sun during the midday hours and using sunscreen.
- 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 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.
- 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.
- 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.
- 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.
- 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.
- Home treatment for sleep problems includes going to bed at the same time every night and getting exercise during the day.
- 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.
- 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.
Medicines for melanoma include:
- Chemotherapy with single or several medicines, such as dacarbazine or temozolomide.
- Immunotherapy with interferon or interleukin-2.
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 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.
The most common types of surgery used to treat melanoma include:
- Local excision. This surgery takes out the melanoma and a little of the tissue around it.
- Wide local excision. This surgery removes more of the tissue around the melanoma. Lymph nodes may also be removed during this surgery.
- 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.
- 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.
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:
- Acupuncture, to relieve pain.
- Meditation or yoga, to relieve stress.
- Massage and biofeedback, to reduce pain and ease tension.
- Breathing exercises for relaxation.
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
|American Academy of Dermatology|
|P.O. Box 4014|
|Schaumburg, IL 60168|
|Phone:||1-866-503-SKIN (1-866-503-7546) toll-free
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.
|American Cancer Society (ACS)|
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.
|American Melanoma Foundation|
|12395 El Camino Real|
|San Diego, CA 92130|
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.
|National Cancer Institute (NCI)|
|6116 Executive Boulevard|
|Bethesda, MD 20892-8322|
|Web Address:||www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)|
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.
|Skin Cancer Foundation|
|149 Madison Avenue|
|New York, NY 10016|
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.
- 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.
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Specialist Medical Reviewer||Alexander H. Murray, MD, FRCPC - Dermatology|
|Last Revised||July 27, 2012|
Last Revised: July 27, 2012
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