Overview
Melanoma is a type of skin cancer. It begins when pigment-producing (color-producing) cells, called melanocytes, begin to change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Melanoma can appear in an area no different from the surrounding skin, or it can develop from or near a mole. It is found most frequently on the back or on a woman’s legs, but melanoma can occur anywhere on the body, including the head and neck. This section describes melanoma of the skin.
The skin is the body’s largest organ. It protects against infection and injury and helps regulate body temperature. The skin also stores water and fat and produces vitamin D. Skin is made up of two main layers: the epidermis (outer layer of skin) and the dermis (inner layer of skin). The deeper layer of the epidermis contains melanocytes. Melanoma starts in melanocytes and is the most aggressive type of skin cancer. It can grow deep into the dermis, invading lymph and blood vessels. The initial type of treatment is determined by the thickness of the tumor.
Risk Factors and Prevention
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as sunbathing, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
The following factors may raise a person’s risk of developing melanoma:
Individual history. People with many moles or unusual moles called dysplastic nevi (flat, large moles that have irregular color and shape) have a higher risk of developing melanoma. About 50% of people with melanoma have dysplastic nevi. Also, people who have weakened immune systems or use certain medications that suppress immune function have a higher risk of developing skin cancer. In addition, people who have had one melanoma have an increased risk of developing additional new melanomas; overall, in the general population, 3% of people who develop one melanoma develop other new melanomas. People who have had a non-melanoma skin cancer also have a somewhat increased risk of developing melanoma.
Family history. Approximately 10% of people with melanoma have a family history of the disease. Therefore, it is recommended that close relatives (parents, brothers and sisters, and children) of a person with melanoma routinely have their skin examined. Changes in two genes (CDKN2A andCDK4) that may lead to melanoma have been identified. However, only a small number of families with melanoma have changes to these genes. Genetic testing for these two genes is only available through clinical trials (research studies). It is likely that other genes and environmental factors also affect risk of melanoma. Learn more about the genetics of melanoma.
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Symptoms
People with melanoma may experience the following symptoms. Sometimes, people with melanoma do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. The skin features that people with melanoma frequently develop are listed below. If you are concerned about a symptom or skin feature on this list, please talk with your doctor.
Changes in the skin are often the first warning sign of melanoma. An accurate diagnosis by a doctor or other health-care professional is important. Often, the diagnosis can only accurately be made after a lesion is removed and examined under a microscope. Melanoma can appear anywhere on the body, even on areas that are not exposed to the sun, and can appear in a number of different ways:
- A new, possibly large, irregularly shaped, dark brownish spot with darker or black areas
- A simple mole that changes in color (particularly turning darker), size (growing), or texture (becoming firmer), and/or flakes or bleeds
- An unusual lesion with an irregular border and red, white, blue, gray, or bluish-black areas or spots
- Shiny, firm, dome-shaped bumps that are new, changing, or unusual anywhere on the body
Treatment
The treatment of melanoma depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. The team may include a surgical oncologist (a doctor who specializes in treating cancer with surgery), a medical oncologist (a doctor who specializes in treating cancer with medication), a radiation oncologist (a doctor who specializes in giving radiation therapy to treat cancer), a dermatologist (a doctor who specializes in diseases and conditions of the skin), and a pathologist.
This section outlines treatments that are the standard of care (best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options.
Surgery
Melanoma can often be successfully treated if it is diagnosed and treated when the tumor is relatively thin. Most melanomas are found when they are thin (less than 1.0 mm) and when outpatient surgery is often the only treatment needed. A doctor will remove the tumor and some healthy tissue around it to make sure no cancer cells remain. The amount of normal tissue removed depends on the thickness of the melanoma. If the melanoma has grown deep into the skin, lymph nodes near the tumor may be removed and examined for cancer cells. Sometimes, the doctor may recommend a sentinel lymph node biopsy (see below). This may be an outpatient procedure or require an overnight stay in the hospital.
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Sleep /Rest Important during cancer why?
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