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Melanoma
Melanoma
What is melanoma?
Melanoma is a type of skin cancer. It begins in certain cells in the skin called melanocytes. Each year more than 53,600 people in the United States find out they have melanoma. To understand melanoma, it is helpful to know about the skin and about melanocytes, what they do, how they grow, and what happens when they become cancerous.
THE SKIN
The skin is the body's largest organ. It protects us against sunlight, injury, and infection. It helps regulate body temperature, stores water and fat, and produces vitamin D. The skin has two main layers: the outer epidermis and the inner dermis.
The epidermis is mostly made up of flat, scalelike cells called squamous cells. Round cells called basal cells lie under the squamous cells in the epidermis. The lower part of the epidermis also contains melanocytes.
The dermis contains blood vessels, lymphatic vessels, hair follicles, and glands. Some of these glands produce sweat, which help regulate body temperature, and some produce sebum, an oily substance that helps keep the skin from drying out. Sweat and sebum reach the skin's surface through tiny openings called pores. 
Healthy cells that make up the skin normally grow, divide, and replace themselves in an orderly way as the body needs them. This helps keep the skin in good repair.
MELANOCYTES AND MOLES
Melanocytes are spread throughout the lower part of the epidermis. They produce melanin, the pigment that gives our skin its natural color. When skin is exposed to the sun, melanocytes produce more pigment, causing the skin to tan, or darken.
Sometimes, melanocytes grow in a cluster. Benign (not cancerous) clusters of melanocytes are called moles. (Doctors also call a mole a nevus; the plural is nevi). Moles are very common. Most people have between 10 and 40 of these brown, tan, or black areas on the skin. Moles can be flat or raised. They are usually round or oval and smaller than a pencil eraser. They can be present at birth or appear later, usually before age 40. Moles generally grow or change only slightly over a long period of time. They tend to fade away in older people. When moles are surgically removed, they normally do not return.
CANCER
Cancer is a group of diseases with one thing in common: cells become abnormal, dividing too often and without control or order. These malignant (cancerous) cells form a tumor and can invade and destroy nearby tissue. The cancer cells can also spread through the lymphatic system or the bloodstream to other parts of the body and form new tumors. The spread of cancer is called metastasis.
MELANOMA
Melanoma occurs when melanocytes become malignant. The disease is also referred to as cutaneous melanoma or malignant melanoma. (Another type of melanoma, ocular melanoma, develops in the eye and is not discussed here).
Melanoma can occur on any skin surface. In men, it is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the lower legs or the trunk. Melanoma is rare in black people and others with dark skin. When it does develop in dark-skinned people, it tends to occur under the fingernails or toenails, or on the palms or soles. Melanoma affects people of all age groups, but the chance of developing this disease increases with age.
What are signs and symptoms of melanoma?
Often, the first sign of melanoma is a change in the size, shape, or color of an existing mole. It can also appear as a new, abnormal, or "ugly-looking" mole.
Thinking of "ABCD" can help you remember what to watch for:
A Asymmetry - The shape of one half does not match the other.
B Border - The edges are ragged, notched, or blurred.
C Color - The color is uneven. Shades of black, brown, and tan may be present . Areas of white, gray, red, or blue may be seen.
D Diameter - There is a change in size.
When melanoma develops in an existing mole, the texture of the mole can change. For example, it can become hard, lumpy, or scaly. Although a melanoma may feel different and may itch, ooze, or bleed, it usually does not cause pain.
How is melanoma detected early?
It is important that melanoma be detected as early as possible. The disease can be cured if it is diagnosed and treated when the tumor is thin and has not deeply invaded the skin. However, if a melanoma is not removed early, cancer cells can grow downward from the skin surface, invading healthy tissue. When a melanoma becomes thick and deep, the disease often spreads to other parts of the body and is difficult to control.
To help detect melanoma at an early stage, individuals can regularly check their own skin for new growths or other changes. Changes in the skin or a mole found during a self-exam should be reported to the doctor without delay. The person may be referred to a dermatologist, a doctor who specializes in diseases of the skin.
People who have had melanoma have a high risk of developing a new melanoma. Also, those with relatives who have had this disease have a higher-than-average risk. It is especially important for these people to check their skin regularly and to have frequent medical exams.
Some people have certain abnormal-looking moles, called dysplastic nevi or atypical moles, that may be more likely than normal moles to develop into melanoma. Most people with dysplastic nevi have just a few of these abnormal moles; others have many. They should examine these moles regularly for changes and consult their doctor for examinations.
Dysplastic nevi often closely resemble melanoma. Doctors with special training in skin diseases are in the best position to decide whether an abnormal-looking mole should be closely watched or should be removed and checked for cancer.
In some families, many members have a large number of dysplastic nevi, and some have had melanoma. Members of these families have a very high risk for melanoma. It is important for them to have frequent checkups (every 3 to 6 months) so that any problems can be detected early. The doctor may take pictures of a person's skin to help in detecting any changes that occur.
How is melanoma diagnosed?
If the doctor suspects that a spot on the skin is melanoma, a biopsy is performed. A biopsy is the only method of making a definite diagnosis. In this procedure, the doctor removes part or all of the suspicious-looking growth. This can usually be done in the doctor's office using a local anesthetic. A pathologist then examines the tissue under a microscope to check for cancer cells. Sometimes it is helpful for more than one pathologist to look at the tissue to determine whether melanoma is present.
If melanoma is found, the doctor needs to learn the extent, or stage, of the disease before planning treatment. The treatment plan takes into account the thickness of the tumor, how deeply the melanoma has invaded the skin, and whether melanoma cells have spread to nearby lymph nodes or other parts of the body. Removal of nearby lymph nodes for examination under a microscope is sometimes necessary. (Such surgery may be considered part of the treatment, because removing cancerous lymph nodes can help control the disease.) The doctor conducts a thorough physical examination and, depending on the thickness of the tumor, may order chest x-rays, blood tests, and scans of the liver, bones, and brain.
How is melanoma treated?
After diagnosis and staging, the doctor develops a treatment plan to fit each patient's needs. Treatment for melanoma depends on the extent of disease, the patient's age and general health, and other factors.
Surgery to remove (excise) a melanoma is the standard treatment for this disease. It is necessary to remove not only the tumor but also some normal tissue around it to decrease the chance that any cancer cells will be left in the area.
The width of surrounding skin that needs to be removed depends on the thickness of the melanoma and how deeply it has invaded the skin. In cases in which the melanoma is very thin, enough tissue is usually removed during the biopsy, and no further surgery is necessary. If the melanoma was not completely removed during the biopsy, the doctor operate again to excise the remaining tumor and a narrow margin of normal-looking tissue around it. For thick melanomas, it may be necessary to remove a larger margin of normal-looking tissue.
If a large area of tissue is removed, a skin graft may be done at the same time. For this procedure, the doctor uses skin from another part of the body to replace the skin that was removed. The doctor may also take out nearby lymph nodes.
Surgery generally is not effective in controlling melanoma that has spread to other parts of the body (metastasis). In such cases, doctors may use other methods of treatment, such as chemotherapy, biological therapy, radiation therapy, or a combination of these methods. Some patients participate in clinical trials of new treatments. These trials are designed to answer scientific questions and to determine whether a new treatment is both safe and effective. Patients who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved treatment methods.
Chemotherapy (treatment with anticancer drugs) is a systemic treatment, meaning that it can affect cancer cells throughout the body. One or more anticancer drugs are given by mouth or by injection into a blood vessel. Either way, the drugs enter the bloodstream and travel through the body. Chemotherapy is frequently used when melanoma spreads from its original site to other parts of the body.
When melanoma occurs only on an arm or leg, doctors sometimes administer anticancer drugs in another way. In a technique called perfusion, the flow of blood to and from the limb is stopped for a while with a tourniquet. Anticancer drugs are then put into the blood of the limb. The patient receives high doses of drugs in the area where the melanoma occurred.
Biological therapy (also called biotherapy or immunotherapy) is a treatment that helps the body's immune system fight disease more effectively. This form of treatment often involves the use of substances called biological response modifiers (BRMs). The body normally produces these substances in small amounts in response to infection and disease. Using modern laboratory techniques, scientists can produce BRMs in large amounts for use in cancer treatment. Interleukin-2 and interferon are two examples of BRMs being tested for the treatment of advanced melanoma in clinical trials.
Doctors do not yet know whether chemotherapy or biological therapy given soon after surgery can help prevent melanoma from recurring. This form of treatment, known as adjuvant therapy, is under study in clinical trials. Doctors may suggest that certain patients who are at high risk for recurrence, such as those whose melanoma is deep or has spread to nearby tissue, participate in a clinical trial.
Occasionally, radiation therapy (also called radiotherapy) is used to treat melanoma. Radiation therapy is the use of high-energy rays to damage cancer cells and stop them from growing. Like surgery, radiation therapy is a local therapy; it affects only the cells in the treated area. Radiation therapy is most commonly used to help control melanoma that has spread to the brain.
Patients with melanoma who are interested in taking part in a trial of a new treatment method should discuss this option with their doctor.
What are the side effects of treatment?
Treatment of melanoma is designed to minimize side effects to the extent possible in any given case. For example, to avoid causing large scars, the least possible amount of tissue is removed without increasing the chance of recurrence. In general, scars from surgery to remove an early stage melanoma are small (often 1 to 2 inches long), and they fade with time. When a tumor is large and thick, more surrounding skin and tissue (including muscle) are removed. Although skin grafts reduce scarring from the removal of large growths, these scars will often be quite noticeable.
Surgery to remove the lymph nodes from the underarm or groin may damage the lymphatic system and slow the flow of lymph in the arm or leg. Lymph may build up in a limb and cause swelling (lymphedema). Certain exercises or other methods can be implemented to reduce swelling if it becomes a problem. Additionally, following removal of lymph nodes, it is more difficult for the body to fight infection in a limb. The patient will, therefore, need to protect the arm or leg from cuts, scratches, bruises, or burns that can lead to infection. If an infection does develop, the patient should consult a doctor or health professional immediately.
Although chemotherapy, biological therapy, and radiation therapy are very carefully tailored to a particular case, it is difficult to limit the effects of these treatments so that only cancer cells are destroyed. Because healthy cells can also be damaged, cancer treatments often cause unpleasant side effects.
The side effects of these treatments vary. They depend mainly on the type and extent of treatment. Additionally, each patient reacts differently. Patients are carefully monitored so that any problems that occur can be addressed.
The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, cause the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more susceptible to fever or an infection, can bruise or bleed more easily, and may have less energy. Cells in the hair follicles and cells that line the digestive tract also divide rapidly. Accordingly, chemotherapy can cause hair loss and other problems such as mouth sores, poor appetite, nausea, and vomiting. The drugs commonly used to treat melanoma can also cause shortness of breath, kidney problems, tingling or numbness of the fingers, toes, or face, and some hearing loss. Most of the side effects of chemotherapy resolve after treatment stops. However, some side effects, such as tingling, numbness, and hearing loss, may continue even after chemotherapy is over.
The side effects caused by biological therapies vary with the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Sometimes, patients develop a rash, bleed or bruise easily, or retain fluid. These problems can be severe, and patients may need to be hospitalized during treatment.
The side effects of radiation therapy depend on the amount of radiation given and the area being treated. Patients who receive radiation therapy for melanoma that has spread to the brain usually receive 2 weeks of treatment. Side effects that can occur during treatment include headache and fatigue. Patients often lose their hair, but it usually grows back after treatment.
Loss of appetite can be a problem for patients during therapy. People may not feel hungry when they are uncomfortable or tired. Also, some of the common side effects of cancer treatment, such as nausea, vomiting, or a change in the person's sense of taste, can make eating difficult. Yet good nutrition is important because patients who eat well generally feel better and have more energy. In addition, they may be better able to withstand the side effects of treatment. Eating well means receiving enough calories and protein to help prevent weight loss, regain strength, and rebuild normal tissues. Many patients find that eating several small meals and snacks during the day works better than having three large meals.
What happens after treatment?
Melanoma patients have an increased risk of developing new melanomas. Some also are at risk for a recurrence of the original melanoma in nearby skin or in other parts of the body.
To increase the chance that a new melanoma will be detected as early as possible, patients should follow their doctor's schedule for regular checkups. It is especially important for patients who have dysplastic nevi and a family history of melanoma to have frequent checkups. Patients should also examine their skin monthly (keeping in mind the "ABCD" guidelines) and follow their doctor's advice about how to reduce their chances of developing another melanoma.
The chance of recurrence is greater for patients whose melanoma was thick or had spread to nearly tissue than for patients with very thin melanomas. Follow-up care for those who have a high risk of recurrence can include x-rays, blood tests, and scans of the liver, bones, and brain.
How do patients cope with cancer?
The diagnosis of melanoma can change the lives of patients and the people who care about them. These changes can be hard to handle. Patients and their families and friends may have many different and sometimes confusing emotions.
At times, patients and those close to them may be frightened, angry, or depressed. These are normal reactions when people face a serious health problem. Many people handle these thoughts and feelings best when they share them with their loved ones. Sharing can help everyone feel more at ease and can open the way for others to show their concern and offer support.
Worries about tests, treatments, hospital stays, and medical bills are common. Doctors, nurses, or other members of the health care team can help calm fears and ease confusion about treatment, working, or other activities. Patients may want to talk with them about the future, family relationships, finances, and other concerns. It can also help to talk with a social worker, counselor, or member of the clergy, especially about feelings and other personal matters.
Patients and their families are naturally concerned about what the future holds. Sometimes they use statistics to try to figure out whether the patient will be cured or how long he or she will live. It is important to remember, however, that statistics are averages based on large numbers of patients. They can't be used to predict what will happen to a certain patient because no two cancer patients are alike. The doctor who takes care of the patient and knows his or her medical history is in the best position to discuss the person's outlook (prognosis).
People should feel free to ask the doctor about their prognosis, but not even the doctor knows for sure what will happen. When doctors talk about surviving cancer, they may use the term remission rather than cure. Even though many patients who have early stage melanoma recover completely, doctors use this term because melanoma can recur.
Are there support groups for cancer patients?
Living with a serious disease is difficult for patients and those who care about them. Everyone involved faces problems and challenges. Finding the strength to cope with these difficulties is easier when people have helpful information and support services.
Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. Also, many patients find it helpful to meet and talk with others who are facing problems like theirs. Cancer patients often get together in support groups, where they can share what they have learned about cancer and its treatment and about coping with the disease. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another, even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor or nurse.
The health care team can recommend a variety of helpful resources. Often, a social worker at the hospital or clinic can suggest local and national groups that provide emotional support, financial aid, transportation, or home care. The American Cancer Society is one such group. This nonprofit organization has many services for patients and their families. Local offices of the American Cancer Society are listed in the white pages of the telephone book.
Information about other programs and services is available through the Cancer Information Service. The toll-free number is 1-800-4-CANCER.
Can melanoma be prevented?
Doctors can seldom explain why one person gets melanoma and another doesn't. However, we do know that this disease is not contagious; no one can "catch" cancer from another person.
The number of people who develop melanoma is increasing. Researchers are trying to learn what may cause it. It is believed that the number of melanomas may be increasing mainly because people are spending more time in the sun. It is known that ultraviolet (UV) radiation from the sun causes skin damage that can lead to melanoma. Artificial sources of UV radiation, such as sunlamps and tanning booths, also can cause skin damage.
Scientists have observed that certain factors increase a person's risk of developing melanoma. Having two or more close relatives who have had this disease is a risk factor because melanoma sometimes runs in families. In fact, about 10 percent of all patients with this disease have family members who also have had melanoma. When melanoma runs in a family, the family members should be checked regularly by a doctor.
Having dysplastic nevi (atypical moles) is another risk factor for melanoma. Dysplastic nevi are more likely than ordinary moles to become cancerous. Many people have only a few of these abnormal moles; the risk of melanoma is greater for people who have a large number of dysplastic nevi. It is highest for people who have a family history of both dysplastic nevi and melanoma.
People who have had one or more severe, blistering sunburns as a child or teenager are at increased risk for melanoma. Because of this, doctors advise protecting children's skin from the sun, which they hope will help prevent melanoma later in life.
Melanoma occurs more frequently in people who have fair skin that burns or freckles easily (these people also usually have red or blond hair and blue eyes) than in people with dark skin. White people contract melanoma far more often than do black people, probably because light skin is more easily damaged by the sun. In addition, this disease is more common in people who live in areas that are exposed to high levels of UV radiation from the sun. In the United States, for example, melanoma is more common in Texas than it is in Minnesota, where the sun is not as strong.
To help prevent melanoma, people should avoid exposure to the midday sun (from 10 a.m. to 2 p.m. standard time, or from 11 a.m. to 3 p.m. daylight savings time) whenever possible. Another simple rule is to protect yourself from the sun when your shadow is shorter than you are. Wearing a hat and long sleeves offer protection. Lotions or creams that contain sunscreens can help prevent sunburn. Doctors believe sunscreens may help prevent melanoma, especially those that block both types of ultraviolet radiation. Sunscreens are rated in strength according to a sun protection factor (SPF), which ranges from 2 to 15 and higher. Those rated 15 or higher provide the best protection. Melanoma At A Glance - Melanoma is a skin cancer that begins in cells called melanocytes.
- Melanocytes can grow together to form benign (not cancerous) moles.
- A change in size, shape, or color of a mole can be a sign of melanoma.
- Melanoma can be cured if detected early, before spread (metastasis) to other areas of the body.
- Diagnosis of melanoma is confirmed with a biopsy of the abnormal skin.
- Treatment of melanoma depends on the extent of disease, and the patient's age and general health.
- Sun exposure can cause skin damage that can lead to melanoma.
RESOURCES
Information about cancer is available from many sources, including the ones listed below. You may wish to check for additional information at your local library or bookstore and from support groups in your community.
CANCER INFORMATION SERVICE (CIS)
1-800-4-CANCER
The Cancer Information Service, a program of the National Cancer Institute, provides a nationwide telephone service for cancer patients and their families and friends, the public, and health care professionals. The staff can answer questions and can send booklets about cancer. They also know about local resources and services.
The toll-free number, 1-800-4-CANCER (1-800-422-6237), connects callers with the office that services their area. Spanish- speaking staff members are available.
AMERICAN CANCER SOCIETY (ACS)
1599 Clifton Road, N.E.
Atlanta, GA 30329
1-800-ACS-2345
The American Cancer Society is a voluntary organization with a national office (at the above address) and local units all over the country. It supports research, conducts educational programs, and offers many services to patients and their families.
To obtain information about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under "American Cancer Society" in the white pages of the telephone book.
SKIN CANCER FOUNDATION
Suite 2402
245 Fifth Avenue
New York, NY 10016
212-725-5176
This nonprofit organization provides publications and audiovisual materials on the prevention, early detection, and treatment of skin cancer. The foundation also publishes Sun and Skin News and The Skin Cancer Foundation Journal, which have nontechnical articles on skin cancer. Send a stamped, self-addressed envelope to receive free printed information.
AMERICAN ACADEMY OF DERMATOLOGY
P. O. Box 4014
930 North Meacham Road
Schaumburg, IL 60168-4014
708-330-0230
The American Academy of Dermatology is an organization of doctors who specialize in diagnosing and treating skin problems. It provides free booklets on skin cancer and can refer people to dermatologists in their area.
Last updated on 05/15/2008
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