Melanoma is a kind of skin cancer. It is not 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 does not cover melanoma that occurs in the eye or in any other part of the body besides the skin.
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.
Melanoma tends to run in families. Other things in your family background can increase your chances of getting the disease. For example, you may have abnormal, or atypical, moles. Atypical 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 many atypical moles increases your risk of melanoma. Also, it may be a sign that melanoma runs in your family.
Melanoma may grow in a mole or birthmark that you already have. But melanomas may grow in unmarked skin. They 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.
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.
Unlike a normal mole or mark, a melanoma can:
Your doctor will check your skin to look for melanoma. If your doctor thinks 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.
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. Your doctor will talk with you about how you can lower your chances of having another melanoma.
If your melanoma is very deep or has spread to your lymph nodes, your doctor may talk with you about taking a medicine called interferon. Or your doctor may recommend that you enroll in a clinical trial.
The best way to prevent all kinds of skin cancer, including melanoma, is to protect yourself whenever you are out in the sun. It's important to avoid exposure to the sun's ultraviolet (UV) rays.
Check your skin every month for odd marks, moles, or sores that will not heal. 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. Even though the biggest cause of melanoma is spending too much time in the sun, it can be found on parts of your body that never see the sun.
Frequently Asked Questions
Learning about melanoma:
Living with melanoma:
Health Tools help you make wise health decisions or take action to improve your health.
|Actionsets are designed to help people take an active role in managing a health condition.|
|Skin Cancer: Protecting Your Skin|
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. Use the ABCDE rule to evaluate skin changes, and call your health professional if you have any of the following changes.
Signs of melanoma in an existing mole include changes in:
Melanoma can develop in an existing mole or other mark on the skin, but it often develops in unmarked skin. Although melanoma can grow anywhere on the body, it 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
Later signs of melanoma include:
Symptoms of metastatic melanoma may be vague and include:
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. Although melanomas can begin in an existing mole or other skin growth, most start in unmarked skin. Melanoma is classified as primary or metastatic.
If not treated, most melanomas spread to other parts of the body over time. Melanomas rarely go away without treatment.
Your long-term survival, or prognosis, with primary melanoma depends on:
Metastatic melanoma has spread through the lymph system to nearby skin, lymph nodes, or through the bloodstream to other organs such as the brain or the liver. Metastatic melanoma usually cannot be cured. Clinical trials may offer the best treatment option for people with metastatic cancer.
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 do not necessarily show what will happen to you. The estimated 5-year survival rate for melanoma is:2
Risk factors for melanoma include:1
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:
Call your doctor immediately if you have been diagnosed with melanoma and:
Watchful waiting, or surveillance, is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate for melanoma. See your doctor if you have any suspicious changes in a mole or other skin growth. Melanoma can be cured if it is diagnosed early, before it grows or spreads.
The following health professionals can help diagnose melanoma:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
A physical exam of the skin is used to evaluate the skin for melanoma. If melanoma is suspected, a skin biopsy will be done. For this, your doctor will remove a sample of skin tissue and send it to a pathologist to be looked at under a microscope. If the biopsy shows melanoma, the pathologist will measure the thickness of the melanoma to find out how advanced the cancer is.
Other techniques may include total-body photography to monitor 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.
Your doctor will do a physical exam that includes checking the lymph nodes to see whether they are larger than normal. This may be followed by a sentinel lymph node biopsy to see whether the melanoma has spread to the lymph system.
A complete medical history and a physical exam are needed to find out whether the cancer has spread (metastasized) to other parts of the body. Imaging tests, including positron emission tomography (PET scan), computed tomography (CT scan), or magnetic resonance imaging (MRI), may be used to identify metastases in other parts of the body, such as the lungs, brain, liver, or other organs.
Skin self-exam is a good way to detect early skin changes that may point to melanoma. A skin self-exam is used to find suspicious growths that may be cancer or growths that may develop into skin cancer (precancers). Adults should examine their skin once every month. Look for any abnormal skin growth or any change in the color, shape, size, or appearance of a skin growth. Check for any area of injured skin (lesion) that does not heal. Have your spouse or someone such as a close friend help you monitor your skin, especially places that are hard to see such as your scalp and back.
There are other steps you can take to prevent skin cancer or detect it at an early stage.
Surgical removal (excision) of the affected skin is the most effective treatment for melanoma. Excision involves removing the entire melanoma along with a border (margin) of normal-appearing skin. More treatment may be needed based on the stage of the melanoma.
Melanoma may be cured if caught and treated in its early stages when it affects only the skin. If melanoma is confined to the skin (primary melanoma), you will have surgery to remove the affected skin. If the melanoma is thin and has not invaded surrounding tissues, excision may cure the melanoma. In more advanced stages, melanoma may spread, or metastasize, to other organs and bones, requiring additional treatment such as radiation, chemotherapy, or immunotherapy.
Treatments used for melanoma include:
Side effects of treatment
The side effects of treatment for melanoma will depend on the type of treatment you have and your age and overall health. The side effects of surgery, chemotherapy, or radiation may be mild enough that you can do things at home to manage them. See the Home Treatment section of this topic for more information.
Some of the treatment side effects can be avoided. For example, your doctor may prescribe medicines to control nausea and vomiting caused by chemotherapy. Be sure to talk to your doctor about all the side effects that you have.
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.
Learn to do a skin self-exam and to check for swelling in your lymph nodes, and report any changes to your doctor. It's a good idea to get in the habit of doing this skin and lymph-node check at the same time every month.
Swollen or tender lymph nodes may be a sign that the melanoma has spread (metastatic melanoma). Any enlarged regional lymph nodes should be removed and checked for melanoma.
When melanoma has spread to only one tumor in another location, metastatic melanoma sometimes can be successfully treated with surgery. But metastatic melanoma usually responds poorly to most forms of treatment.
When successful treatment is not possible, the goal of treatment for metastatic melanoma is to control symptoms, reduce complications, and increase comfort (palliative care).
Your doctor may recommend that you join a clinical trial if one is available in your area. Clinical trials study other treatments, such as combinations of chemotherapy, vaccines, and immunotherapies. They are also studying targeted therapy with agents such as PLX4032 and ipilimumab.
Melanoma can come back after treatment. This called recurrent melanoma. This kind of melanoma, like metastatic melanoma, usually cannot be cured with treatment. But your medical team will keep you comfortable and help you live as long as possible. Treatments that may help include:
Palliative care may be an important part of your treatment plan.
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It is 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 is 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.
Cancer treatment has two main goals: to cure the cancer and to make your quality of life as good as possible. 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 aimed at prolonging your life and shift the focus to end-of-life care. For more information, see the topics:
For more information about specific treatments, see the following topics:
There are many risk factors for developing melanoma. The risk factor you can best control to reduce your risk of melanoma is exposure to ultraviolet (UV) radiation from the sun.
To help prevent skin cancer:
For more information, see:
People who burn rather than tan, especially those who have red hair or blue eyes, also have a high risk and should take extra precautions to prevent melanoma.
For more information about prevention of melanoma, see the following topics:
Home treatment can help you manage the side effects that may occur from your treatment. Some treatments for melanoma, such as taking interferon or having chemotherapy, can have serious side effects. 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.
Other issues may include:
Not all forms of cancer or cancer treatment cause pain. If pain occurs, many treatments are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment may help to reduce pain and improve your physical and mental well-being. Be sure to talk with your doctor about any home treatment you use for pain.
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 you reduce your stress.
Your feelings about your body may change following a diagnosis of melanoma and the need for treatment. Adapting to your body image changes may involve 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 additional support and information.
Medicines for melanoma include chemotherapy with a single medicine or several medicines. Medicines for treatment may include immunotherapy or even a combination of chemotherapy and immunotherapy.
Medicine for melanoma that has metastasized may include:
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 leg, chemotherapy medicines may 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.
Medicines being studied in clinical trials include combinations of chemotherapy, vaccines, and immunotherapies. Clinical trials are also looking at targeted therapy with the monoclonal antibody ipilimumab and a medicine called PLX4032.
Surgery is the most common treatment for melanoma and is done to remove the primary melanoma. Sometimes 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 tumors that may have spread to other parts of the body.
The most common types of surgery used to treat melanoma include:
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.
Clinical trials are currently studying many other treatments. These include new forms of chemotherapy and immunotherapy, such as monoclonal antibodies and vaccines. Your doctor may recommend that you join a clinical trial if one is available in your area.
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. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
|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://cissecure.nci.nih.gov/livehelp/welcome.asp# 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.
- International Agency for Research on Cancer Working Group on Artificial Ultraviolet Light and Skin Cancer (2006). The association of use of sunbeds with cutaneous melanoma and other skin cancers: A systematic review. International Journal of Cancer, 120: 116–1122.
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||December 17, 2010|
Last Revised: December 17, 2010
To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.