Melanoma

What is melanoma?#

Melanoma is the most dangerous type of skin cancer. It may appear as a new spot or as a change in an existing mole or freckle. Over 95% of skin cancers can be successfully treated if they are found early.

If untreated, melanomas can spread to other parts of the body and may not be curable, so it is important to see your doctor as soon as you notice any changes to your skin.

The biggest risk factor for developing a melanoma is exposure to ultraviolet (UV) radiation, from the sun or from artificial sources such as solariums (sunbeds).

Types of skin cancer#

The three major types of skin cancer are:

• melanoma
• squamous cell carcinoma
• basal cell carcinoma

Melanoma is most commonly diagnosed in people aged 55 and over. However, young adults, teenagers and even children can be affected.

Causes of melanoma#

Melanoma and other skin cancers generally develop from overexposure to UV radiation. Each time unprotected skin is exposed to UV radiation from the sun or artificial sources, changes take place in the structure of the cells. Too much UV radiation causes permanent skin damage that worsens with each exposure. Skin cancer can grow when the cells that make up your skin are damaged and begin to grow abnormally.

Every additional decade of overexposure to UV further increases your risk of skin cancer, so increased use of sun protection helps prevent skin cancer and melanoma at any age.

All skin types can be damaged by exposure to UV radiation. People with skin types that are less likely to burn are still at risk of developing skin cancer, although this risk is lower than for people with skin types that are more likely to burn. The melanin in naturally very dark skin offers some protection against the damaging effects of UV radiation and lowers the risk of skin cancer. However, when skin cancer is detected in people with naturally very dark skin, it is often found at a later, more dangerous stage, when the risk of death is much higher.

Risk of melanoma#

People with one or more risk factors are at increased risk of melanoma. Risk factors include:

• pale or fair skin, or skin that burns easily and does not tan
• lots of moles on the skin
• a number of large, irregularly shaped and unevenly colored moles
• previous melanomas
• a history of many sunburns from overexposure to UV
• a family history of melanoma
• being older, as risk increases with age

Symptoms of melanoma#

The first sign of a flat melanoma is usually a new spot, or an existing mole or freckle that changes in appearance. Changes might include:

• the spot growing larger
• edges that look irregular rather than smooth
• mottling with a range of colors, such as brown, black, blue, red, white or light gray
• the spot becoming itchy or bleeding

Melanoma can grow very quickly. It can become life-threatening in as little as 6 weeks and, if untreated, can spread to other parts of the body. Melanoma can also appear on skin not normally exposed to the sun.

Nodular melanoma is a highly dangerous form that looks different from common melanomas. Nodular melanomas are raised and even in color, often red or pink, and some are brown or black. This type grows quickly and can be life-threatening if not detected and removed quickly. See your doctor immediately if you notice any of these changes.

Checking for melanoma#

It is important to get to know your skin and what is normal for you, so you notice any changes quickly. Check all of your skin, not just sun-exposed areas. If you notice anything unusual, including any change in the shape, color or size of a spot, or the development of a new spot, visit your doctor immediately.

While melanomas usually occur on parts of the body that have been sunburned, they can sometimes start in parts of the skin or other parts of the body that have never been exposed to the sun. Melanomas on the arms and legs are usually detected earlier and have a better chance of successful treatment than melanomas on the body, neck or head, which are often detected at a later stage.

Once a melanoma has been diagnosed and treated, you are advised to have regular skin checks, as there is an increased risk of further melanomas developing. Melanomas are not contagious, and you cannot catch them from someone else.

Diagnosis of melanoma#

Melanoma is diagnosed by:

• physical examination, including your medical history
• excision biopsy, in which the suspected melanoma and some surrounding skin are removed under local anesthetic and examined in a laboratory for signs of cancer

Test results can take a few days to come back, and it is natural to feel anxious while waiting. It can help to talk to a close friend or relative about how you are feeling.

If a melanoma is diagnosed, further tests may be needed if surgery is planned or to see whether the cancer has spread. These tests may include blood tests, a chest x-ray, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) scan, bone scan and lymph node biopsy.

Treatment of melanoma#

Your doctor will advise you on the best treatment for your cancer. This depends on the type of cancer, where it is, how far it has spread, your general health and what you want. Most people with melanoma need to have surgery.

Surgery. Melanomas are usually removed by surgery, except when the melanoma is too advanced. The surgeon also removes some normal-looking skin around the melanoma, called a “margin of safety,” which varies from 5 mm to 2 cm. The purpose is to remove any cancer cells in the surrounding skin and prevent the melanoma from growing back at the same site. Most people can have the skin sewn up with normal stitches; if extra tissue is needed to close the wound, a skin graft or flap may be required.

Biological therapies and immunotherapy. Biological therapies use substances made naturally by the body. Some are called immunotherapy because they help the immune system fight the cancer. Many biological therapies, including monoclonal antibodies and vaccine therapy, are being researched and trialled and may help treat people with melanoma in the future. Targeted therapy may also be used in some cases.

Radiotherapy. Radiotherapy uses radiation to destroy or injure cancer cells, targeted onto cancer sites in the body. Treatment is carefully planned to do as little harm as possible to normal tissue. You will probably have radiotherapy once a day from Monday to Friday over several weeks, with a break on weekends. The number of visits depends on the size and type of the melanoma and on your general health. The treatment itself takes only a few minutes and is not painful. It does not make you radioactive, so it is quite safe to be close to your partner, children and others during the course of treatment.

Complementary and alternative treatments. It is common for people with cancer to seek out complementary or alternative treatments. Used alongside conventional treatment, some can make you feel better and improve your quality of life, while others may not be helpful and in some cases may be harmful. Tell all your healthcare professionals about any complementary medicines you use, and never stop your conventional treatment without consulting your doctor first.

All treatments can have side effects. These days, new treatments can make many side effects much less severe than they were in the past.

Long-term outlook#

Survival for people with melanoma has improved significantly over recent decades, particularly when the cancer is found and treated early. The prognosis is generally better for women than for men. Your medical history is unique, so discuss with your doctor what you can expect and which treatment options are best for you.

When melanoma can’t be cured#

If your cancer has spread and it is not possible to cure it by surgery, your doctor may still recommend treatment. In this case, treatment may help relieve symptoms, make you feel better and allow you to live longer. Whether or not you choose to have anti-cancer treatment, symptoms can still be controlled; for example, if you have pain, there are effective treatments for it. Primary care doctors, specialists and palliative care teams all play important roles in helping people with cancer.

Risk of further melanomas#

Most people treated for early melanoma do not have further trouble with the disease. However, when there is a chance the melanoma may have spread, you will need regular self-surveillance and professional check-ups. Your doctor will decide how often you need check-ups, as everyone is different, and they will become less frequent if you have no further problems.

After treatment for melanoma it is important to limit exposure to UV radiation. A combination of sun protection measures, such as clothing, a hat, shade, sunscreen and sunglasses, should be used whenever UV levels are high (when the UV index is forecast to be 3 or above). Because biological family members often share similar traits, your relatives may also have an increased risk of melanoma and other skin cancers. They can reduce their risk by spending less time in the sun and using sun protection when UV is high.

Monitor your skin regularly, and if you notice any changes, or enlarged lymph glands near where you had the cancer, see your specialist as soon as possible.

Caring for someone with cancer can be a difficult and emotional time, and support is available for carers.

Key points#

• Melanoma is the most dangerous type of skin cancer, and is most commonly diagnosed in people aged 55 and over.
• The biggest risk factor is exposure to UV radiation from the sun or artificial sources.
• Too much UV radiation permanently damages the skin, and the damage worsens with each exposure.
• Every additional decade of overexposure to UV further increases your risk of skin cancer.
• Increased use of sun protection helps prevent skin cancer and melanoma at any age.

Where to get help#