Understanding Melanoma: Risks, Types, Stages, Prevention, and Treatments

Melanoma is one of the most serious forms of skin cancer, originating in the pigment-producing cells called melanocytes. It is critical to understand the risks, symptoms, and treatment options associated with melanoma, as early detection and treatment significantly improve outcomes. This comprehensive guide will explore what melanoma is, its symptoms, types, stages, risk factors, prevention strategies, and treatment options.

What is Melanoma?

Melanoma is a type of skin cancer that develops from melanocytes, the cells responsible for producing melanin, the pigment that gives skin its color. Unlike other skin cancers, melanoma has a higher likelihood of spreading (metastasizing) to other parts of the body, which makes it more dangerous. It can occur anywhere on the skin but is more commonly found on areas exposed to the sun, such as the face, back, arms, and legs. Melanoma can also develop in the eyes (ocular melanoma) and, more rarely, in internal organs.

In 2023, the American Cancer Society estimated that nearly 100,000 new cases of melanoma would be diagnosed in the United States, with approximately 7,990 deaths. Despite being less common than other skin cancers, melanoma accounts for the majority of skin cancer-related deaths, emphasizing the importance of early detection and treatment.

Melanoma Symptoms and Appearance

Melanoma often presents as a new spot on the skin or a change in an existing mole. The ABCDE rule is a helpful guide for identifying potential melanomas:

• Asymmetry: One half of the mole does not match the other half.
• Border: The edges are irregular, ragged, notched, or blurred.
• Color: The color is not uniform and may include shades of brown, black, pink, red, white, or blue.
• Diameter: Melanomas are usually larger than 6 millimeters (about the size of a pencil eraser), though they can be smaller when first detected.
• Evolving: Any change in size, shape, color, or elevation, or new symptoms such as bleeding, itching, or crusting, indicates possible melanoma.

Other symptoms can include sores that do not heal, redness or swelling beyond the border of a mole, or a mole that feels itchy, tender, or painful.

Are There Different Types of Melanomas?

Yes, there are several types of melanomas, each with distinct characteristics. Understanding the different types is crucial for accurate diagnosis and treatment.

1. Superficial Spreading Melanoma: This is the most common type of melanoma, accounting for about 70% of cases. It typically appears as a flat or slightly raised discolored patch with irregular borders and is more likely to occur in younger people.
2. Nodular Melanoma: This type is more aggressive and is often recognized as a bump on the skin that is usually black, but can also be blue, gray, white, brown, tan, red, or skin-colored. It grows more quickly in depth than other types of melanoma.
3. Lentigo Maligna Melanoma: This type usually occurs in older adults and develops in areas of long-term sun exposure, such as the face, ears, and arms. It often begins as a large, flat, tan or brown patch that grows slowly over time.
4. Acral Lentiginous Melanoma: This rare type is more common in people with darker skin and typically appears on the palms of the hands, soles of the feet, or under the nails. It is not related to sun exposure.
5. Desmoplastic Melanoma: This rare form of melanoma tends to develop on sun-exposed areas and may resemble a scar. It often has no pigment, making it harder to recognize.
6. Hidden Melanomas: Hidden melanomas develop in areas not commonly associated with sun exposure and are more difficult to detect. They can occur under the nails (subungual melanoma), in the mouth, digestive tract, urinary tract, or in the eyes. These melanomas often go unnoticed until they are in more advanced stages, making them more challenging to treat.

Explaining the Stages of Melanoma

Melanoma staging is based on the thickness of the tumor, ulceration (whether the skin covering the melanoma is broken), and whether it has spread to the lymph nodes or other parts of the body. The stages are classified from 0 to IV:

• Stage 0 (In Situ): The melanoma is confined to the top layer of the skin (epidermis) and has not invaded deeper tissues.
• Stage I: The melanoma is less than 2mm thick and may or may not be ulcerated. It has not spread to the lymph nodes or distant sites.
• Stage II: The melanoma is thicker (greater than 2mm) and may be ulcerated but has not spread to the lymph nodes or other parts of the body.
• Stage III: The melanoma has spread to nearby lymph nodes or nearby skin or lymphatic channels but not to distant sites.
• Stage IV: The melanoma has spread to distant lymph nodes, organs, or tissues. Stage IV melanoma is also referred to as metastatic melanoma and is more challenging to treat.

Common Melanoma Risk Factors

Several factors can increase the risk of developing melanoma:

• Ultraviolet (UV) Radiation Exposure: Prolonged exposure to UV radiation from the sun or tanning beds is the most significant risk factor. A history of severe sunburns, especially during childhood, can increase the risk.
• Fair Skin: Individuals with fair skin, light hair, and light-colored eyes are more susceptible to melanoma because they have less melanin, which provides some protection against UV radiation.
• Moles: Having many moles or atypical (dysplastic) moles increases the risk of melanoma.
• Family History: A family history of melanoma increases the likelihood of developing the disease, especially if multiple family members are affected.
• Personal History: Individuals who have had melanoma before are at higher risk of developing it again.
• Weakened Immune System: People with weakened immune systems, such as those who have had organ transplants or have HIV/AIDS, are at increased risk of melanoma.

Melanoma Prevention: How to Limit Your Risk

Preventing melanoma largely revolves around minimizing UV exposure and protecting your skin from the sun:

• Use sunscreen: Regular use of a broad-spectrum sunscreen with an SPF of 30 or higher can protect your skin from harmful UV rays. Reapply every two hours, or more often if swimming or sweating. Read more tips on using sunscreen correctly
• Avoid peak sun hours: UV rays are strongest between 10 a.m. and 4 p.m. If possible, stay indoors during these hours or seek shade when outside.
• Wear protective clothing: Long-sleeved shirts, pants, wide-brimmed hats, and sunglasses can provide additional protection.
• Avoid tanning beds: Tanning beds expose your skin to high levels of UV radiation and significantly increase the risk of melanoma.
• Regular skin checks: Perform self-examinations monthly to check for new moles or changes in existing ones. Pay attention to areas not commonly exposed to the sun, such as the scalp, soles of the feet, and under the nails.

Annual Skin Checks: Early Diagnosis is Key to a Good Outcome

Annual skin checks by a dermatologist are crucial for early detection of melanoma. Dermatologists are trained to spot suspicious moles or lesions that may not be obvious to the untrained eye. Early diagnosis is critical, as melanomas detected at an early stage are much easier to treat and have a higher survival rate. According to the American Academy of Dermatology, the 5-year survival rate for early-stage melanoma is about 99%, but it drops significantly for more advanced stages.

Diagnosing Melanoma: The Biopsy Procedure

If a suspicious mole or lesion is found, a dermatologist will perform a biopsy to diagnose melanoma. There are several types of biopsies:

• Excisional Biopsy: The entire mole or lesion and a small margin of surrounding skin are removed. This is the preferred method for diagnosing melanoma.
• Incisional Biopsy: A portion of the mole or lesion is removed for examination.
• Punch Biopsy: A circular tool is used to remove a small section of skin, including the deeper layers, for analysis.
• Shave Biopsy: The top layers of the skin are shaved off for examination. This method is less common for suspected melanoma because it may not capture the full depth of the lesion.

The biopsy sample is then examined under a microscope by a pathologist to determine if melanoma is present, and if so, the thickness and characteristics of the melanoma, which help determine the stage.

Melanoma Treatment Options

Treatment for melanoma depends on the stage of the disease, the location of the tumor, and the patient’s overall health. Treatment options can be surgical or non-surgical and can include:

• Surgical excision: This is the primary treatment for early-stage melanoma. The surgeon removes the melanoma and a margin of surrounding healthy skin to ensure that all cancerous cells are removed. Mohs surgery, a specialized technique, may be used for melanomas on the face or other sensitive areas. Mohs surgery involves removing the tumor layer by layer, examining each layer under a microscope until no cancerous cells remain. This technique helps preserve as much healthy tissue as possible.
• Chemotherapy: Although not as commonly used for melanoma as for other cancers, chemotherapy may be recommended for advanced melanomas that have spread to other parts of the body. Chemotherapy drugs kill cancer cells or stop them from growing. It can be administered orally, intravenously, or topically.
• Radiation therapy: Radiation therapy uses high-energy rays to target and destroy cancer cells. It may be used after surgery to kill any remaining cancer cells, especially if the melanoma has spread to the lymph nodes. It can also be used to relieve symptoms in advanced-stage melanoma.
• Immunotherapy: This treatment helps boost the body’s immune system to fight cancer. Several immunotherapy drugs, such as checkpoint inhibitors (e.g., pembrolizumab, nivolumab), have been approved for melanoma. These drugs work by blocking proteins that prevent immune cells from attacking cancer cells. Immunotherapy has been particularly effective in treating advanced melanoma, with some patients achieving long-term remission.

How Treating Early-Stage vs. Late-Stage Melanoma Differs:

• Early-stage: Treatment primarily involves surgical excision, often with a high cure rate. The goal is to remove the melanoma before it has spread.
• Late-stage: Treatment becomes more complex and may involve a combination of surgery, chemotherapy, radiation, and immunotherapy. The focus shifts from cure to controlling the spread of the disease, relieving symptoms, and improving quality of life.

Understanding melanoma’s risks, symptoms, and treatment options is essential for early detection and effective management. Regular skin checks, both self-examinations and annual visits to a dermatologist, can lead to early diagnosis, which is critical for successful treatment. While prevention strategies can reduce the risk, awareness and vigilance remain key in the fight against melanoma.

Hubert Chodkiewicz, MD is a board-certified dermatologist and fellowship-trained in Mohs micrographic surgery, cosmetic dermatology, and the treatment of varicose vein disease. He is additionally certified by The American Board of Venous and Lymphatic Medicine. Dr. Chodkiewicz completed his dermatology residency at The University of Texas at Houston/M.D. Anderson Cancer Center where he served as chief resident during his final year.