Melanoma is a form of skin cancer that begins in cells known as Melanocytes. Melanocytes are skin cells found in the upper layer of skin. They produce a pigment known as melanin, which gives skin its color. It can spread to other organs more rapidly if it is not treated at an early stage. Melanoma is much less common than some other types of skin cancers. But melanoma is more dangerous because it’s much more likely to spread to other parts of the body if not caught and treated early.
Melanoma is caused by changes (mutations) in skin cells called melanocytes. These cells make a skin color pigment called melanin. Melanin is responsible for skin and hair color.
Melanoma can appear on normal skin. Sometimes it can develop from moles. Moles that are present at birth may develop into melanomas. Larger moles that are present at birth may be at higher risk of developing melanoma.
There are four major types of melanoma:
• Superficial spreading melanoma is the most common type. It is usually flat and irregular in shape and color, with different shades of black and brown. It is most common in fair skin people.
• Nodular melanoma usually starts as a raised area that is dark blackish-blue or bluish-red. Some do not have any color (amelanotic melanoma).
• Lentigo maligna melanoma usually occurs in older people. It is most common in sun-damaged skin on the face, neck, and arms. The abnormal skin areas are usually large, flat, and tan with areas of brown.
• Acral lentiginous melanoma is the least common form. It usually occurs on the palms, soles, or under the nails. It is more common in non-Caucasian skin.
The risk of developing melanoma increases with age. However, more and more young people are developing it.
You are more likely to develop melanoma if you:
• Have fair skin, blue or green eyes, or red or blond hair
• Live in sunny climates or at high altitudes
• Spent a lot of time in high levels of strong sunlight because of a job or other activities
• Have had one or more blistering sunburns during childhood
• Use tanning devices, such as tanning beds
Other risk factors include:
• Having close relatives with melanoma
• Certain types of moles (atypical or dysplastic) or many birthmarks
• Weakened immune system due to disease or medicines
Early Signs of Melanoma
Melanomas develop at any part of the body. Often the first sign of melanoma is a change in the size, shape, color, or feel of a mole.
● Lesion asymmetry or border irregularity on moles
● Bleeding or crusting
● Recent changes in moles
● Variation of color on existing moles (though some are non-pigmented)
● Diameter over 7 millimeters
● Development of an elevated area (or palpable nodule)
Who treats melanoma skin cancer?
Depending on the options, you may have different types of doctors on the treatment team.
These doctors may include:
● A dermatologist: a doctor who treats diseases of the skin
● A surgical oncologist (or oncologic surgeon): a doctor who uses surgery to treat cancer
● A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy, immunotherapy, or targeted therapy
● A radiation oncologist: a doctor who treats cancer with radiation therapy
Many other specialists may be involved in the care as well, including physician assistants (PAs), nurse practitioners (NPs), nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.
Treatment of melanoma skin cancer depends upon the stage of the disease, the location of the tumor, and the overall health of the patient.
Surgery to remove the tumor is the primary treatment of all stages of melanoma. Wide local excision is used to remove the melanoma and some of the normal tissue around it. Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery. Sometimes, it is important to know whether cancer has spread to the lymph nodes.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy is used to treat melanoma and may also be used as palliative therapy to relieve symptoms and improve quality of life.
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.
Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy does.
Exams and Tests
Your health care provider will check your skin and look at the size, shape, color, and texture of any suspicious areas with a dermatoscope.
If your provider thinks you might have skin cancer, a piece of skin from the growth will be removed. This is called a skin biopsy. The sample is sent to a lab for examination under a microscope.
A sentinel lymph node (SLN) biopsy may be done in some people with melanoma to see if cancer has spread to nearby lymph nodes.
Once melanoma has been diagnosed, CT scans or other types of x-rays may be done to see if cancer has spread.