Melanoma (patient information)

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Melanoma
Overview
What are the symptoms?
Who is at highest risk?
Diagnosis
Diseases with similar symptoms
Treatment options
Where to find medical care for Melanoma?
Prevention
What to expect (Outlook/Prognosis)?
Melanoma On the Web
Ongoing Trials at Clinical Trials.gov
Images of Melanoma
Videos on Melanoma
FDA on Melanoma
CDC on Melanoma
Melanoma in the news
Blogs on Melanoma
Directions to Hospitals Treating Melanoma
Risk calculators and risk factors for Melanoma

Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview

Melanoma is a cancer that starts in the melanocytes. Although much less common than basal cell and squamous cell skin cancers, melanoma causes most skin cancer deaths. Usually, the first sign of melanoma is a change in the size, shape, color ,or feel of a mole. The ABCDE rule can help you tell a normal mole from an abnormal mole. Melanoma can be cured only if it is diagnosed and treated early. When it spreads to other parts of the body, the outlook could be very bad.

What are the symptoms of Melanoma?

Usually, the first sign of melanoma is a change in the size, shape, color, or feel of a mole. The ABCD rule can help you tell whether the mole is normal or not. Moles that have any of these signs should be checked by your doctor:

• Asymmetry: When one half of the mole does not match the other half.

• Border irregularity: The edges of the mole look ragged, blurred, or notched.

• Color: The color over the mole is not the same and may have shades of tan, brown, or black, and sometimes patches of pink, red, blue, or white.

• Diameter: The mole is larger than about 1/4 inch, although sometimes melanomas can be smaller.

• Evolution over time: The mole is growing or changing in shape or color.

Some melanomas do not fit the above mentioned "rules" and may be hard to tell if the mole is normal or not. Only a doctor can tell for sure. A person with any of these symptoms should seek medical care as early as possible.

Who is at highest risk?

Clinical data has suggested that the development of melanoma is related to several factors.

• Sunlight (solar UV radiation): Too much exposure to sunlight (solar UV radiation) is thought to be the biggest risk factor for most melanomas.

• Moles: Although as a benign skin tumor, the mole increases the chance of developing melanoma, especially for people with multiple moles.

• Genetic factors: Epidemiological data show that Whites with fair skin, freckles, or red/blonde hair have a higher risk of melanoma than the other races.

• Immunosuppressive factors: Clinical surveys suggest that patients treated with Immunosuppressive medication, such as transplant patients, have an increased risk of developing melanoma.

• Previous melanoma: A person with previous history of melanoma has a higher risk of developing melanoma.

• Xeroderma pigmentosum (XP): Patients with xeroderma pigmentosum (XP) are at a higher risk of developing melanoma because they can not repair cell damage caused by sunlight.

• Age: Epidemiological data suggest that melanoma can affect both the old and younger population.

• Gender: Men have a higher chance of developing melanoma than women.

Diagnosis

Regular self-examinations are key to early detection of melanoma. If you see a suspicious skin lesion, it is advised to check up with your dermatologist.

• Biopsy: Initially, dermatologists diagnose skin cancer via visual inspection of the skin and mucous membranes. Then, if malignancy is suspected, a biopsy is performed, which is the most important measure for the diagnosis of melanoma.

• Imaging such as computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, ultrasound, and x-ray: The goal of imaging is to help find out the extent of the melanoma and determine the stage of the disease.

When to seek urgent medical care?

Call your dermatologist if symptoms of melanoma develop.

Treatment options

Patients with melanoma have many treatment options. The treatment plan depends on the stage of the tumor. The available treatment options encompass surgery, radiation therapy, chemotherapy, immunotherapy , or a combination of these. Before treatment starts, ask your health care team about the possible side effects of treatment and how treatment may affect your normal activities. Since cancer treatments often damage healthy cells and tissues, side effects are common. The side effects may not be the same for every person, and they may change from one treatment session to the next.

• Surgery: Surgery is the main treatment in most cases of melanoma. It can often cure early stage melanomas. Once the melanoma has spread from the skin to distant organs, the aim of surgery is to remove the distant secondary lesions and help patients live longer with a better quality of life.

• Radiation therapy: This is a cancer treatment used to kill cancer cells or keep them from growing by using high-energy radiation. Radiation therapy may be used to treat a recurring lesion that cannot be removed by surgery, and distant secondary lesions spread to the brain or the bone.

• Chemotherapy: This treatment involves the use of drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Usually, chemotherapy is useful in treating cancer that has spread.

• Immunotherapy: This kind of treatment helps patient's immune system to adapt and attack the cancer cells. The immunotherapy used to treat advanced melanoma involves cytokines, interferon-alpha, melanoma vaccines, and oncolytic virus therapy.

Diseases with similar symptoms

• Benign junctional nevus

• Cellular blue nevus

• Basal cell carcinoma

• Sclerosing angioma

• Seborrheic keratosis

Where to find medical care for melanoma?

Directions to Hospitals Treating melanoma

Prevention of Melanoma

The best way to lower the risk of melanoma is to avoid too much exposure to the sun and other sources of UV light. Regular self check-up is also important.

• Sun protection practices: Slip on a shirt, slop on sunscreem, slap on a wide-brimmed hat, stay in the shade, wear sunglasses.

• Avoid other sources of UV light: Avoidance of tanning beds and sun lamps.

• Check for abnormal moles and have them removed: Regular self examinations and dermatologist check-ups.

• Genetic counseling and testing: If you have a previous or family history of melanoma, it is advised to check-up with your dermatologist for genetic counseling and testing.

What to expect (Outlook/Prognosis)?

The prognosis of melanoma depends on the following:

• The stage of melanoma: Whether the cancer is found in the outer layer of skin only, or has spread to the lymph nodes, distant locations in the body

• The location and size of the tumor

• Presence of bleeding or ulceration at the site of the melanoma

• The patient’s general health

Resources

Medlineplus

Cancer.org

Patient information

• What You Need To Know About Moles and Dysplastic Nevi - patient information booklet from cancer.gov (PDF)
• MPIP: Melanoma patients information page
• Melanoma Support Organisation (Victoria, Australia) - Ran by Melanoma Sufferers with strong links to Cancer Institutes in Victoria, Australia
• Melanoma Patients Australia
• Mikes Page - The Melanoma Resource Center
• MEL-L - Melanoma e-mail list for patients, caregivers and healthcare professionals - Supporting the Melanoma Patient since 1996