Skin Cancer, Melanoma

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
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What is melanoma?

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. Luckily, it can be cured if it’s found and treated early.

What causes melanoma?

You can get melanoma by spending too much time in the sun. This 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.” These moles don't cause cancer by themselves. But having many of them is a sign that melanoma may run in your family.

What are the symptoms?

The main sign of melanoma is a change in a mole or other skin growth, such as a birthmark. Any change in the shape, size , or color of a mole may be a sign of melanoma.

Melanoma may grow in a mole or birthmark that you already have. But melanomas usually 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 looks 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 can be 6 mm (0.2 in.) or larger.

Unlike a normal mole or mark, a melanoma can:

• Change color.
• Be lumpy or rounded.
• Become crusty, ooze, or bleed.

How is melanoma diagnosed?

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.

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.

Depending on where the melanoma is on your body, and how thick it is, the surgery to remove it may leave a scar. You might need another surgery to repair this scar.

After surgery, your doctor will want to see you every 3 to 6 months for the next 5 years. During these visits, your doctor will check to see if the cancer has returned and if you have any new melanomas.

If your melanoma is very deep or has spread to your lymph nodes, you may need medicine called interferon to fight the cancer cells.

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. It’s important to avoid exposure to the sun’s ultraviolet (UV) rays.

• Try to stay out of the sun during the middle of the day (from 10 a.m. to 3 p.m.).
• Wear protective clothes when you are outside, such as a hat that shades your face, a long-sleeved shirt, and long pants.
• Get in the habit of using 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. 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

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	Protecting your skin from ultraviolet radiation and skin cancer

The most common causes of melanoma are:

• Exposure to ultraviolet radiation.
  • Damage to the DNA of melanocytes from exposure to the sun and its UV light radiation is one of the most important factors in the cause of melanoma. Other factors, such as family history of melanoma, put you at higher risk, but exposure to the sun is the factor you can best control.
  • The sun is most intense between 10:00 a.m. and 3:00 p.m. when it is more directly overhead. It is also more intense when you are at high altitudes.
  • Severe sunburn during childhood increases the risk of melanoma as an adult.¹
  • Tanning salons also expose your body to UV radiation and appear to increase your risk of developing melanoma.²
  • Treatment of psoriasis with the combination of psoralen and UVA (PUVA) increases the risk of melanoma for several years after treatment is finished.³
  • The depletion of the ozone layer may be affecting the incidence of melanoma.
• Family history of melanoma.
• Atypical moles.
• An impaired immune system, especially if you have had an organ transplant, leukemia, or lymphoma.

Early signs

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 American Cancer Society's ABCD rule to evaluate skin changes, and call your health professional if you have any of the following changes.⁴

• 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 pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance. Changes in color distribution, especially the spread of color from the edge of a mole into the surrounding skin, also are an early sign of melanoma.
• D is for diameter . The mole or skin growth is larger than 6 mm (0.2 in.) or about the size of a pencil eraser. Any growth of a mole should be of concern.

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, or burning.
• Consistency, such as softening or small pieces that break off easily (friability).

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 frequently occurs on the upper back of men and women and on the legs in women. Less commonly, it can develop on the soles, palms, nail beds, or mucous membranes that line body cavities such as the mouth, the rectum, and the vagina.⁵

Many other skin conditions (such as seborrheic keratosis, warts, and basal cell cancer) have features similar to those of melanoma.

Later symptoms

Later signs of melanoma include:

• A break in the skin or bleeding from a mole or other colored skin lesion.
• Pain in a mole or lesion.

Symptoms of metastatic melanoma may be vague and include:

• Swollen lymph nodes, especially in the armpit or groin.
• A colorless lump or thickening under the skin.
• Unexplained weight loss.
• Gray skin (melanosis).
• Ongoing (chronic) cough.
• Headaches.
• Seizures.

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 previously unmarked skin. Melanoma is classified as primary or metastatic.

Primary melanoma

Primary melanoma usually follows a predictable pattern of growth through the skin layers. Early detection and surgery to remove the melanoma cure most cases of primary melanoma.

If not treated, most melanomas eventually spread to other parts of the body. Melanomas rarely disappear without treatment.

Your long-term survival, or prognosis, with primary melanoma depends on:⁶

• How deeply the melanoma penetrates the skin (melanoma thickness).
• Whether an open sore is present over the primary tumor (ulceration).

Metastatic melanoma

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. Early detection and removal of primary melanomas before they metastasize offer the best hope for cure.

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. It is important to 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:⁴

• 98% if cancer is found early and treated before it has spread.
• 64% if the cancer has spread to close-by tissue.
• 16% if the cancer has spread farther away, such as to the liver, brain, or bones.

Risk factors for melanoma include:³

• History of exposure to ultraviolet (UV) radiation.
  • Sun exposure is one of the most important risk factors for melanoma. Other factors, such as family history of melanoma, put you at higher risk, but exposure to the sun is the factor you can best control. Extensive exposure to the sun can occur during childhood, in jobs that require a person to work outside, and during outdoor activities.
  • UV exposure at tanning salons may be just as risky as sunbathing.²
• History of sunburns, especially during childhood.
• Previous melanoma or other skin cancer.
• Family history of melanoma or FAM-M syndrome.
• Atypical moles (dysplastic nevi).
• 50 or more moles at least 3 mm (0.1 in.) across.
• White race, especially people who have fair skin that burns rather than tans, freckles, red hair, or blue eyes.
• Impaired immune system.
• Moles that are present at birth, especially if the moles are larger than 20 cm (7.9 in.) (giant congenital melanocytic nevus).
• A rare inherited disease called xeroderma pigmentosum. This is a disease in which the body cannot repair damage to cells by UV radiation from the sun.
• PUVA treatment, used to treat skin conditions such as psoriasis.⁷

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 health professional 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 health professional immediately if you have been diagnosed with melanoma and:

• You have difficulty breathing or swallowing.
• You cough up or spit up blood (hemoptysis).
• You have blood in your vomit or bowel movement.
• Your urine or bowel movement is black, and the blackness is not caused by taking iron or Pepto-Bismol.

Watchful Waiting

Watchful waiting, or surveillance, is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate for melanoma. See your health professional 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.

Who To See

The following health professionals can help diagnose melanoma:

• Family medicine doctor
• Internist
• Dermatologist
• Nurse practitioner
• Physician assistant

Once melanoma is suspected, a biopsy is needed to make a diagnosis. Your health professional will remove a sample of tissue so that a pathologist can examine it under a microscope to check for cancer cells.

If further treatment or excision is needed, melanoma can be treated by a dermatologist, surgeon, plastic or reconstructive surgeon, or medical oncologist.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Evaluation of a skin lesion

A physical exam of skin is used to evaluate the skin for melanoma. If melanoma is suspected, a skin biopsy will be done. For this, your health professional will remove a sample of skin tissue and send it to a pathologist to be examined under a microscope. If the biopsy shows melanoma, the pathologist will measure the thickness of the melanoma to determine how advanced the cancer is.³

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 photographs of the suspicious lesions is taken as a baseline for comparison against later, follow-up photos.

Evaluation of lymph nodes

Testing the lymph nodes may not be necessary if the melanoma is less than 1 mm (0.04 in.) thick when measured with a microscope, because the risk of the cancer spreading may be low. You can expect more lab tests if your melanoma is large or thick.

If a melanoma is thicker than 1 mm (0.04 in.), your health professional 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 lymph node biopsy to see whether the melanoma has spread to the lymph system.

A sentinel lymph node biopsy is a relatively new technique that may be used as an alternative to conventional lymph node biopsy. Like a conventional biopsy, sentinel lymph node biopsy is done to identify lymph nodes that may contain melanoma.

Evaluation for possible metastases (spread of cancer)

A complete medical history and physical exam are needed to determine 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.

Early Detection

Skin self-exam is a good way to detect early skin changes that may indicate melanoma, because most primary melanomas are easily seen on the surface of the skin.³ A skin self-exam is used to identify 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.

• Be aware of the risk of skin cancer and the steps you can take to prevent it, including using sunscreen, wearing protective clothing, and staying out of the midday sun.
• Have your health professional examine any suspicious skin changes. Screening guidelines from the American Cancer Society and other expert groups recommend that adults older than 40 have their skin checked by a health professional at least once a year, as well as during any other health exam. This may lead to early treatment and prevent the possible spread of cancer. You may wish to begin screening earlier, especially if you have:
  • Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to develop melanoma. Examine your skin every month and be examined by a doctor every 4 to 6 months, preferably by the same doctor each time.
  • Increased occupational or recreational exposure to ultraviolet (UV) radiation.
  • Abnormal moles called atypical moles (dysplastic nevi). These moles are not cancerous, but their presence is a warning of an inherited tendency to develop melanoma.

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. Additional treatment may be needed based on the stage of the melanoma.

Staging for treatment of melanoma

Staging is a method of describing how far a cancer has progressed. It is done after excision of the melanoma and assessment of lymph nodes and other parts of the body to determine whether the cancer has spread. Staging helps doctors determine the best possible treatment. Staging evaluates:⁶

• Tumor thickness and depth.
• Ulceration of skin over the melanoma.

Initial treatment

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, making cure less likely.

Initial treatment will depend on the stage of the melanoma.^{8, 9}

• Stage 0 melanoma or melanoma in situ invades only the outer layer of skin. Surgery to remove the lesion or mole is usually all that is needed.
• Stage I melanoma is generally less than 1 mm (0.04 in.) thick. Surgery to remove the cancer is usually all that is needed. Some advanced stage I melanomas may be treated like stage II.
• Stage II melanoma is more than 1 mm (0.04 in.) thick, but does not spread to the lymph nodes. Surgery to remove the cancer is most common. Other treatments your doctor may consider are a lymph node biopsy, a medicine called interferon, observation, or enrolling you in a clinical trial. Reconstructive surgery may be needed to repair the scar left by surgery, especially if it is on the face or hands. Some advanced stage II melanomas may be treated like stage III.
• Stage III melanoma has spread to the lymph nodes. Treatment includes surgery to remove the primary melanoma and all of the lymph nodes near the primary melanoma. This is usually followed by immunotherapy with interferon. Interferon is a protein similar to proteins made by the white blood cells. These proteins act in two ways—by weakening or killing cancer cells and also by boosting the body's immune system to fight the cancer. Your doctor may also talk to you about enrollment in a clinical trial.
• Stage IV melanoma is cancer that has spread far from the initial cancer site, perhaps to the liver, brain, or bones. Treatment may include surgery, radiation, chemotherapy, or immunotherapy with drugs such as interferon. Most treatment in stage IV is to treat the symptoms caused when the cancer spreads to other areas, such as bone pain if the cancer spreads to the bone.

Treatment for melanoma that develops in other places in the body depends on the site. Sites can include:

• The eye (ocular melanoma). In the past, melanoma of the eye often required removal of the eyeball (enucleation). Sometimes it is still necessary to remove the eye, but there are now alternative treatments for some of these cases. Treatment may include radiation, laser treatment called photocoagulation to seal off the blood supply to the cancer, and surgeries that do not remove the entire eyeball.¹⁰
• The skin of a finger or toe or under a nail. Melanoma in these sites is treated by removing (excising) diseased tissue. Often the entire finger or toe will have to be removed.³

Ongoing treatment

Regular follow-up appointments are important once you have been diagnosed with melanoma.¹¹ After surgery to remove melanoma, you will have follow-up appointments every 3 to 6 months for 5 years, then annually. You will continue to have follow-up appointments every 3 to 6 months if you have:

• Abnormal moles called atypical moles (dysplastic nevi). These moles are not cancerous, but their presence is a warning of an inherited tendency to develop melanoma.
• Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to get melanoma.

Treatment if the condition gets worse

Swollen or tender lymph nodes may be a sign that the melanoma has spread. Any enlarged regional lymph nodes should be removed and checked for melanoma.

Stage IV (metastatic) melanoma responds poorly to most forms of treatment. The 5-year survival rate for stage IV melanoma is less than 50%.¹¹ The goal of treatment of metastatic melanoma is to control symptoms, reduce complications, and increase comfort (palliative care). It is not intended to cure the disease. Metastatic melanoma may be treated with:

• Surgery.
• Radiation therapy.
• Chemotherapy with dacarbazine (DTIC). The main side effect from DTIC is nausea and vomiting, which usually can be controlled with antinausea medicines. Another drug called temozolomide is being studied for treating melanoma. Temozolomide may be used to treat cancer that has spread (metastasized) to the brain.
• Immunotherapy with drugs such as interferon.

If you have metastatic melanoma, you may wish to participate in a clinical trial. Check with your doctor to determine whether clinical trials are available in your area.

What To Think About

After removal of a primary melanoma, a skin graft or other reconstructive surgery may be needed for cosmetic reasons or to restore function. This is most likely if the melanoma was large or was a late-stage tumor.

Melanoma can come back after treatment. Learn to do a skin self-exam and to check for swelling in your lymph nodes, and report any changes to your health professional.¹¹ It's a good idea to get in the habit of doing this skin and lymph-node check at the same time every month.

There is no "normal" or "right" way to react to a diagnosis of cancer. There are many steps you can take to help with your emotional reaction to cancer. If your reaction 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. Talking with other people who may have had similar feelings can be very helpful.

End-of-life issues

If you have advanced (metastatic) melanoma, you may choose to stop curative treatment and focus on care that assures your comfort (palliative care). Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to palliative care is difficult. For more information, see the following topics:

Care at the End of Life

Hospice Care

There are many risk factors for developing melanoma. The risk factor you can best control to decrease your risk of melanoma is exposure to ultraviolet (UV) radiation from the sun. Some experts believe that 65% or more of melanoma is caused by exposure to the sun, especially during childhood.¹²

Follow these recommendations to help prevent skin cancer.³

• Protect your skin.
  • Stay out of the sun during the midday hours (10:00 a.m. to 3:00 p.m.).
  • Wear protective clothing. This includes a hat with a brim to shade your ears and neck, a shirt with sleeves to cover your shoulders, and pants. The best fabric for skin protection has a tight weave to keep sunlight out.
  • Use daily a sunscreen with an SPF of at least 15. Look for a sunscreen that protects against both types of ultraviolet radiation in the sun's rays—UVA and UVB.
  • Use a higher SPF when at higher elevations.
  • Set a good example for your children by always using sunscreen and wearing protective clothing.
• Avoid sunbathing and tanning salons. Studies suggest that UV rays from artificial sources such as tanning beds and sunlamps are just as dangerous as those from the sun.²
• Examine your skin regularly, and have your health professional check your skin during any other health exams, or at least once a year.

For more information, see:

Protecting your skin from ultraviolet radiation and skin cancer.

People who live in warm, sunny climates or who have jobs that require them to be outdoors most of the time have an increased risk of developing melanoma. 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.

Some people feel that a tan may protect against a sunburn and therefore protect against skin damage and skin cancer. However, if you do not tan easily, the amount of sun exposure needed to get a tan will cause excessive skin damage and outweigh any possible benefit from having a tan.

For more information about prevention of melanoma, see the following topics:

• Skin cancer, melanoma — Patient Information (Prevention) — [NCI PDQ]
• Skin cancer, melanoma — Health Professional Information (Prevention) — [NCI PDQ]

Home treatment after removal of a melanoma includes protecting your skin from overexposure to ultraviolet (UV) rays and regularly checking your skin for suspicious skin changes.

• Stay out of the sun during the midday hours (10:00 a.m. to 3:00 p.m.).
• Wear protective clothing outdoors. This includes a hat with a brim to shade your ears and neck, a shirt with sleeves to cover your shoulders, and pants. The best fabric for skin protection has a tight weave to keep sunlight out.
• Use daily a sunscreen with an SPF of at least 15. Look for a sunscreen that protects against both types of ultraviolet radiation in the sun's rays—UVA and UVB. Use a higher SPF when at higher elevations.
• Avoid sunbathing and tanning salons.
• Perform a skin self-exam once a month. Check your skin and skin growths for any changes in color, shape, size, or appearance. Learn how to feel your lymph nodes to check for any swelling.
• Look for any diseased area of skin (lesion) that has not healed after an injury.
• Report any suspicious changes in your skin to your health professional.

If you are receiving chemotherapy or radiation for advanced melanoma, you can use home treatment to help manage the side effects that may accompany your treatment. Home treatment may be all that is needed to manage the following problems. If your health professional has given you instructions or medicines to treat these symptoms, 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 a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. For more information on how to deal with these side effects, see:

  Controlling nausea and vomiting caused by chemotherapy.

• Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your health professional before using any nonprescription medicines for your diarrhea.
• Home treatment for constipation includes gentle exercise along with adequate intake of fluids and a diet that is high in fruits, vegetables, and fiber. Check with your health professional 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 stick to your usual routine and just get some extra sleep. Fatigue is often worse at the end of treatment or just after treatment is completed.

Other issues that arise may include:

• Hair loss. This 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 health professional about whether hair loss is an expected side effect with the medicines you will receive.
• Sleep problems. If you find you have trouble sleeping, you may sleep more easily if you have a regular bedtime, get some exercise during the day, avoid naps, and try other methods to relieve sleep problems.

Many people with melanoma face emotional issues as a result of their disease or its treatment.

• 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 health professional. Your health professional may also be able to refer you to organizations that can offer additional support and information.

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 health professional about any home treatment you use for pain.

Interferon given before or after surgery (adjuvant therapy) is standard treatment for melanoma that has spread to the lymph nodes. The use of interferon may increase the survival rate of some people with stage IIB and stage III melanoma.¹³

Melanoma that has spread to distant sites is rarely curable with standard treatment, although several medicines are being studied in clinical trials.

Chemotherapy generally does not increase survival rates for metastatic melanoma. However, the chemotherapy medicine dacarbazine (DTIC) may be used for palliative treatment of stage IV (metastatic) melanoma.

Medication Choices

Medicine treatment for melanoma that has metastasized may include:

• Interferon, which may be used for any melanoma thicker than about 1 mm (0.04 in.). It is commonly used if melanoma has spread to the lymph nodes. Interferon can make cancer cells too weak to protect themselves from the body's immune system. Research shows that interferon can extend the period of time between initial treatment and relapse. Some studies also suggest it can lead to longer life for some people.¹³
• Dacarbazine (DTIC), which may be used for the treatment of stage IV (metastatic) melanoma. The main side effect from DTIC is nausea and vomiting, which usually can be controlled with antinausea medicines. Your health professional will prescribe medicines to be taken with your treatments and when you get home to help relieve any nausea that you may have. These medicines may include:
  • Aprepitant (Emend), which is used in combination with ondansetron and dexamethasone as part of a 3-day program.
  • Dimenhydrinate (Dramamine), which is often used to treat motion sickness. It relieves nausea by blocking motion signals to the brain.
  • Metoclopramide (Reglan), which increases the movements or contractions of the stomach and intestines. This decreases the amount of time it takes for the stomach contents to move through the digestive tract.
  • Phenothiazines, such as Compazine and Phenergan. These medicines stop nausea and vomiting by reducing the activity of the central nervous system.
  • Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril), or dolasetron (Anzemet). These medicines work by blocking the effects of a chemical (serotonin) produced in the brain and in the stomach that controls vomiting. They are often more effective when they are combined with corticosteroids, such as dexamethasone (Hexadrol or Decadron), which reduce swelling in the part of the brain that controls nausea.
• Temozolomide (Temodar) is a drug that can reach the brain, so it is sometimes used to treat melanoma that has spread (metastasized) to the brain.

What To Think About

New forms of chemotherapy are constantly being tested. The success of new medicines and new medicine combinations is determined by clinical trials. Check with your doctor to determine whether clinical trials are available in your area.

Complete surgical removal (excision) is the most successful and the most common treatment for melanoma.³ The lymph nodes may also need to be removed (lymphadenectomy) in stages II and III melanoma.

Metastatic melanoma is also treated with surgery to remove the primary melanoma and cancer from nearby tissue or lymph nodes.

Surgery Choices

The most common types of surgery used to treat melanoma include:

• Surgical excision. Excision removes the entire melanoma along with a border (margin) of normal-appearing skin.
• Lymphadenectomy, or surgery to remove lymph nodes that are cancerous.

What To Think About

Other treatment options are also used for melanomas that occur in rare sites, such as in the eye, on a finger or toe, or under a nail.

Radiation therapy may be used to treat advanced or metastatic melanoma. Radiation therapy uses high doses of radiation to destroy or shrink melanoma with little harm to nearby healthy tissue. Radiation damages the genetic material of cells in the area being treated, leaving the cells unable to continue to grow.

Other types of treatment, including monoclonal antibodies and vaccines, are being studied in clinical trials. No vaccines are currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of melanoma. Check with your doctor to determine whether clinical trials are available in your area.

Complementary therapies

In addition to conventional medical treatment, complementary therapies may improve the quality of your life by helping you manage the stress and side effects of cancer treatment. However, these complementary therapies should not replace standard therapy.

• Acupuncture
• Herbs
• Biofeedback
• Meditation
• Yoga
• Guided imagery
• Vitamins and nutritional supplements

Before you try any of these therapies, discuss their possible benefits and side effects with your health professional. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

There is no "normal" or "right" way to react to a diagnosis of cancer. There are many steps you can take to help with your emotional reaction to cancer. If your reaction 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. Talking with other people who may have had similar feelings can be very helpful.

Online Resource

Organizations

• Skin Cancer, Nonmelanoma
• Skin Changes

Citations

1. Savage P, et al. (2005). Malignant melanoma (non-metastatic). Clinical Evidence (14): 2058–2072.

2. Wang SQ, et al. (2001). Ultraviolet A and melanoma: A review. Journal of the American Academy of Dermatology, 44(5): 837–846.

3. Balch CM, et al. (2005). Cutaneous melanoma. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., vol. 2, pp. 1754–1809. Philadelphia: Lippincott Williams and Wilkins.

4. American Cancer Society (2006). Cancer Facts and Figures 2006, pp. 1–56. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/STT/stt_0.asp.

5. Langley RGB, et al. (2003). Neoplasms: Cutaneous melanoma. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., vol. 1, pp. 917–947. New York: McGraw-Hill

6. American Joint Committee on Cancer (2002). Melanoma of the skin. In AJCC Cancer Staging Manual, 6th ed., pp. 209–220. New York: Springer-Verlag.

7. Stern RS, et al. (2001). The risk of melanoma in association with long-term exposure to PUVA. Journal of the American Academy of Dermatology, 44(5): 755–761.

8. National Comprehensive Cancer Network (2006). Melanoma. Clinical Practice Guidelines in Oncology, version 2. Available online: http://www.nccn.org/professionals/physician_gls/PDF/melanoma.pdf.

9. National Cancer Institute (2006). Melanoma PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/healthprofessional.

10. Avery RB, et al. (2005). Intraocular melanoma. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., vol. 2, pp. 1809–1825. Philadelphia: Lippincott Williams and Wilkins.

11. Martinez J-C, Otley CC (2001). The management of melanoma and nonmelanoma skin cancer: A review for the primary care physician. Mayo Clinic Proceedings, 76(12): 1253–1265.

12. Geller AC, et al. (2002). Use of sunscreen, sunburning rates, and tanning bed use among more than 10,000 U.S. children and adolescents. Pediatrics, 109(6): 1009–1014.

13. Kirkwood JM, et al. (2004). A pooled analysis of Eastern Cooperative Oncology Group and intergroup trials of adjuvant high-dose interferon for melanoma. Clinical Cancer Research, 10(5): 1670–1677.