Melanoma is a kind of skin cancer. It isn't as common as other types of skin cancer, but it is the most serious.
Melanoma usually looks like a flat mole with uneven edges and a shape that is not the same on both sides. It may be black, brown, or more than one color. Most melanomas show up as a new spot or skin growth. But they can form in an existing mole or other mark on the skin.
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 doesn't 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 UV radiation from sun exposure causes normal skin cells to become abnormal. These abnormal cells quickly grow out of control and attack the tissues around them.
You are at higher risk for melanoma if you have fair skin, a family history of melanoma, or many abnormal, or atypical, moles. These 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."
You may not have any symptoms in the early stages of melanoma. Or a melanoma may be sore, or it may itch or bleed.
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. They may be any size but are usually 0.25 in. (6 mm) or larger.
Melanomas 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.
Your doctor will check your skin to look for melanoma. If your doctor thinks that you have melanoma, he or she will remove a sample of tissue (biopsy) from the area around the melanoma. 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.
The best way to prevent all kinds of skin cancer, including melanoma, is to protect yourself whenever you are out in the sun.
Check your skin regularly for odd marks, moles, or sores that will not heal. Check all of your skin, but 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.
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Things that make getting melanoma more likely include your skin type, the color of your hair, and the color of your eyes.
You may not have any symptoms in the early stages of melanoma. Or a melanoma may be sore, or it may itch or bleed.
Most melanomas start as a new skin growth on unmarked skin. The growth may change color, shape, or size. These types of changes are an early sign that the growth is melanoma. But melanoma can also develop in an existing mole or other mark on the skin. Or it may look like a bruise that isn't healing or show up as a brown or black streak under a fingernail or toenail.
Melanoma can grow anywhere on the body. It most often occurs on the upper back in men and women and on the legs in women. Less often, it can grow in other places, such as 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.footnote 1
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. The ABCDE system tells you what changes to look for.
Melanoma in an existing mole
Signs of melanoma in an existing mole include changes in:
Signs of melanoma that has spread
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. Melanomas can begin in an existing mole or other skin growth, but most start in unmarked skin.
When melanoma is found early, it can often be cured by surgery to remove it. But after melanoma spreads, it is harder to 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. Remember that these are only averages. Everyone's case is different, and these numbers don't necessarily show what will happen to you. The estimated 5-year survival rate for melanoma is:footnote 2
A risk factor for melanoma is something that increases your chance of getting this cancer. Having one or more of these risk factors can make it more likely that you will get melanoma. But it doesn't mean that you will definitely get it. And many people who get melanoma don't have any of these risk factors.
Risk factors for melanoma include:footnote 1
Call your doctor now if you have any of these symptoms:
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:
If you have been diagnosed with cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.
To check for melanoma and whether or not it has spread, your doctor may:
Other techniques may include total-body photography to look 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.
Melanoma may be cured if it's found and treated in its early stages when it affects only the skin. If melanoma has spread, it is much harder to treat.
How much and what type of treatment you need depends on the stage.
Treatments for melanoma include:
Melanoma can spread (metastasize) to other parts of the body, where it can cause tumors. When melanoma has spread and appears as a tumor in another part of the body, it sometimes can be successfully treated with surgery. But metastatic melanoma usually needs other treatments, too, such as chemotherapy, interferon, immunotherapy, or radiation therapy.
Metastatic melanoma and melanoma that can't be removed with surgery may be treated with inhibitors.
Melanoma can come back after treatment. This is called recurrent melanoma. All of the treatments mentioned above may be used for recurrent melanoma as well as:
If your melanoma can't be cured, your doctors will try to control symptoms, reduce complications, and keep you comfortable.
Your doctor may recommend that you join a clinical trial if one is available in your area. Clinical trials may offer the best treatment option for people who have metastatic cancer. Clinical trials study other treatments, such as combinations of chemotherapy, vaccines, and immunotherapies. They are also studying targeted therapy.
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.
To learn more about specific treatments for melanoma, go to the National Cancer Institute's website at www.cancer.gov/cancertopics/types/melanoma.
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see the topic Palliative Care.
For some people who have advanced cancer, a time comes when treatment to cure the 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 you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see the topics:
Home treatment can help you manage any side effects that your treatment might cause. 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.
Having cancer can change your life in many ways. For help in managing these changes, see the topic Getting Support When You Have Cancer.
Medicines for melanoma include:
Medicines used to treat melanoma may be given as an outpatient treatment. But sometimes people need a short hospital stay.
Medicines 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 a leg, chemotherapy medicines may be 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.
The side effects of some of the melanoma medicines can be serious.
Surgery is the most common treatment for melanoma. 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 melanoma 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 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.
Radiation treatment is the use of high-energy X-rays to kill cancer cells and shrink tumors. It isn't as effective in treating melanoma as it is in other cancers. But it may be used to reduce the risk of melanoma coming back. Or it may be used when melanoma has spread to other parts fo the body, such as the brain or bone.
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. They are not meant to take the place of standard medical treatment.
- Bailey EC, et al. (2012). Cutaneous melanoma. In LA Goldman et al., eds., Fitzpatrick's Dermatology in General Medicine, 8th ed., vol. 1, pp. 1416–1444. New York: McGraw-Hill.
- American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
Other Works Consulted
- Fisher RA, Larkin J (2010). Malignant melanoma (metastatic), search date March 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
- Habif TP, et al. (2011). Malignant melanoma, lentigo maligna. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 518–526. Edinburgh: Saunders.
- 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. Also available online: http://www.bad.org.uk//site/622/default.aspx.
- National Cancer Institute (2012). Melanoma Treatment PDQ—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page1/AllPages.
- National Cancer Institute (2012). Skin Cancer Prevention PDQ—Health Care Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/prevention/skin/HealthProfessional.
- National Cancer Institute (2012). Skin Cancer Prevention PDQ—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/prevention/skin/Patient.
- National Comprehensive Cancer Network (2012). Melanoma. Clinical Practice Guidelines in Oncology, version 3. Available online: http://www.nccn.org/professionals/physician_gls/PDF/melanoma.pdf.
- U.S. Preventive Services Task Force (2012). Behavioral counseling to prevent skin cancer: Recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf11/skincancouns/skincancounsrs.htm.
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