Melanoma

Facts About Melanoma

Melanoma is the most deadly type of skin cancer (skin cancer is the most common form of cancer in the United States).
In 2022, it is estimated that over 197,000 Americans will be diagnosed with melanoma, with 99,000 of those cases being invasive and 97,000 being in situ.
Melanoma is expected to claim the lives of 7,650 Americans in 2022.
It is important to note that melanoma can occur anywhere on the body, not just on the skin.
Melanoma does not discriminate and affects people of all ages, races, and genders.
In the age group 30-39, melanoma is the fifth most commonly diagnosed form of cancer.
The incidence of melanoma in people under 30 is increasing faster than any other demographic group, particularly in women.
Each year, approximately 400 children in the U.S. are diagnosed with melanoma.
Melanoma rates in the United States have doubled from 1982 to 2011 and continue to increase.
Currently, around 1.3 million people in the U.S. are living with melanoma.
The lifetime risk of developing melanoma is 1 in 40 for Caucasians, 1 in 200 for Hispanics, and 1 in 1,000 for African Americans.
People of color are more likely to develop melanoma in areas that are not typically exposed to the sun, such as the palms of the hands and soles of the feet.
Skin cancer in people of color is often not diagnosed until later stages, making treatment more difficult.
Ocular melanoma, or melanoma of the eye, is the most common primary eye tumor in adults and is diagnosed in around 2,000 cases each year in the U.S.
Mucosal melanoma is a rare form of melanoma that develops in areas such as the sinuses, nasal passages, oral cavity, and vagina, making up about 1% of melanoma cases.

What is a melanocyte?

A melanocyte is a type of cell found in the skin, hair, and eyes that produces a pigment called melanin. Melanin is responsible for giving color to the skin, hair, and eyes. Melanocytes are located in the lower part of the epidermis, the outermost layer of skin. They produce melanin in response to UV radiation from the sun, which is why skin tans when exposed to sunlight. Melanin acts as a natural sunscreen to protect the skin from UV damage. Melanocytes are also found in the eyes, where they help protect the retina from UV damage. They are also present in the hair, where they help to give hair its color. Overall, Melanocytes are important cells in the body for protecting the skin, hair, and eyes from UV radiation and also for giving color to them.

What is melanoma?

Melanoma is a type of skin cancer that develops from melanocytes. Melanoma is a serious form of skin cancer that can spread to other parts of the body if not caught and treated early. It is characterized by the uncontrolled growth of pigment-producing cells, which can form a tumor or lesion on the skin.

What are the risk factors for melanoma?

Excessive exposure to ultraviolet (UV) radiation from the sun or tanning beds.
A family history of melanoma.
Having many moles or unusual moles (dysplastic nevi).
Light skin color and eye color.
Previous melanoma or other skin cancer.
Weak immune system.
Personal history of sunburns, especially in childhood.
Age, as melanoma is more common in older adults.
Living close to the equator, at higher altitudes, or in areas with intense sun exposure.

It is important to note that having one or more of these risk factors does not guarantee that a person will develop melanoma, and some people may develop melanoma without any known risk factors.

Signs and Symptoms of Melanoma

What does melanoma look like?

Melanoma can appear in a variety of forms and can look different from person to person. The most common sign of melanoma is a change in the size, shape, color, or feel of a mole on the skin. Melanoma can also appear as a new mole. The ABCDEs of melanoma are a helpful guide in identifying possible melanoma. They are:

Asymmetry: One half of a mole or birthmark does not match the other.
Border: The border or edges of the mole are irregular, ragged, notched, or blurred.
Color: The color of the mole is not the same all over and may include shades of brown or black, or sometimes with patches of pink, red, white, or blue.
Diameter: The mole is larger than the size of a pencil eraser (about 6mm or 1/4 inch) across.
Evolving: The mole is changing in size, shape, color, or symptoms, such as itching or bleeding.

It's important to note that not all melanomas have these features, so it's important to be aware of any changes in the appearance of moles or any new moles that appear. It's always best to see a dermatologist if you notice any changes or if you have any concerns.

What are the different types of melanoma?

There are four main types of melanoma:

Superficial spreading melanoma: the most common type, which spreads horizontally along the surface of the skin.
Nodular melanoma: which is an aggressive form that grows vertically and can develop anywhere on the body.
Lentigo maligna melanoma: a type that occurs on sun-exposed areas of the skin and often affects older people.
Acral lentiginous melanoma: a type that occurs on the palms of the hands, soles of the feet, or under the nails, and is more common in people with dark skin.

Diagnosis of Melanoma

How is melanoma diagnosed?

The first step in diagnosing melanoma is a physical examination by one of our dermatologists. The doctor will ask questions about your health history and examine the skin for any signs of melanoma. If there is a suspicious skin lesion, the doctor may recommend a biopsy to determine whether it is melanoma. During a biopsy, a sample of tissue is removed and sent to a laboratory for testing and examination.

The type of biopsy recommended by the doctor will vary depending on your specific circumstances. Generally, it is preferred to remove the entire growth if possible. The punch biopsy, which uses a circular blade to press into the skin surrounding the suspicious mole, is a common technique. Another option, and the preferred option, is the excisional biopsy, in which a scalpel is used to cut away the entire mole and a small margin of surrounding healthy tissue.

What happens after I am diagnosed with melanoma?

After being diagnosed with melanoma, the next step is to determine the stage of the cancer. To do this, your dermatologist will:

Assess the thickness. The thickness of a melanoma is determined by a careful examination under a microscope and measuring it with a specialized tool. This helps determine the appropriate treatment plan, as generally, the thicker the melanoma, the more severe the condition. If the melanoma is thin, surgery to remove the cancer and surrounding normal tissue may be the only required treatment. If the melanoma is thicker, further testing may be recommended to determine if it has spread, before deciding on the best treatment options.
Check for lymph node involvement. If there is a possibility that the melanoma has spread to the lymph nodes, a sentinel node biopsy may be recommended. This procedure involves injecting a dye into the area where the melanoma was removed and monitoring its flow to the nearby lymph nodes. The first lymph nodes to receive the dye are then removed and tested for the presence of cancer cells.
Search for possibility of cancer beyond the skin. Physicians may suggest imaging exams, such as X-rays, CT scans, and PET scans, for individuals with progressed melanomas to detect if the cancer has spread to other parts of the body. These imaging exams are usually not suggested for small melanomas with minimal chance of spreading beyond the skin.

Other elements may impact the assessment of cancer's potential to spread (metastasis), including the presence of an open sore (ulceration) on the skin and the number of dividing cancer cells (mitoses) seen under a microscope.

The stage of melanoma is classified using Roman numerals from 0 to IV. At stages 0 and I, the melanoma is small and has a high chance of successful treatment. However, the likelihood of a full recovery decreases with higher numerals. At stage IV, the cancer has spread beyond the skin to other organs such as the lungs or liver.

Treatment of Melanoma

How is melanoma treated?

The most appropriate treatment for melanoma depends on several factors, including the size and stage of the cancer, the individual's general health, and personal preferences.

Treating Early Stage Melanoma (thin/small melanomas):

Treatment for early-stage melanomas generally involves surgical removal of the melanoma. In cases where the melanoma is very thin, the entire growth may be removed during the biopsy, eliminating the need for further treatment. Otherwise, the dermatologist will remove the cancer, along with a margin of normal skin and a layer of tissue beneath the skin. For individuals with early-stage melanomas, this may be the sole required treatment.

Treating Late Stage Melanoma (melanoma that has spread beyond the skin):

Treatment options for melanoma that has spread beyond the skin may include:

Surgery for affected lymph nodes: If the melanoma has spread to nearby lymph nodes, the surgeon may remove the affected nodes, and additional treatments before or after surgery may be recommended.
Immunotherapy: A drug treatment that helps the immune system to fight the cancer. It is often recommended after surgery for melanoma that has spread to the lymph nodes or other areas of the body.
Targeted therapy: Drug treatments that focus on specific weaknesses within cancer cells and cause the cells to die. Cells from the melanoma may be tested to determine if targeted therapy is likely to be effective.
Radiation therapy: A treatment that uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. It may be directed to the lymph nodes if the melanoma has spread there or used to relieve symptoms if the cancer has spread to other areas of the body.
Chemotherapy: A treatment that uses drugs to kill cancer cells, which can be given intravenously, in pill form, or both to travel throughout the body. It can also be given in a vein in an isolated limb perfusion procedure, where the blood in the arm or leg isn't allowed to travel to other areas of the body for a short time, so the chemotherapy drugs travel directly to the area around the melanoma.

Prognosis of Melanoma

What is the prognosis of melanoma?

An estimated 7,650 deaths (5,080 men and 2,570 women) from melanoma will occur in the US in 2023.
From 2015 to 2019, deaths from melanoma decreased by around 4% each year due to treatment advances.
In 2020, an estimated 57,043 people worldwide died from melanoma.
Many people with melanoma are cured by initial surgery.
The 5-year survival rate for all people with melanoma of the skin from the time of initial diagnosis is 93%.
5-year survival depends on the thickness of the primary melanoma, involvement of lymph nodes, and spread of melanoma to distant sites.
For "thin melanoma," 5-year survival is 99%, but for thicker melanoma, it may be 80% or higher.
Survival rates at 5 years for melanoma that has spread to nearby lymph nodes is 63-68%, but it depends on various factors such as the number of lymph nodes involved, genetic changes, amount of tumor, and features of the primary melanoma.