What is Melanoma?

Melanoma develops when the pigment-producing cells of the skin, called melanocytes, become abnormal and grow to form tumors. Melanoma is the most serious type of skin cancer and can affect people of any skin color. Most frequently, melanoma develop in areas of the skin that have had exposure to the sun, such as face, arms, back and legs. In addition to skin, melanoma can develop in the eye and in areas that have little to no exposure to the sun. Very rarely melanoma develops in internal organs. 

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of melanoma. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

 Inspect your skin regularly and look for the ABCDE signs of melanoma:

• A- Asymmetry: an asymmetrical mole is a warning sign for melanoma
• B- Border: borders which are irregular, uneven, scalloped or notched. 
• C- Color: a mole that is made up of a variety of different colors is a warning sign for melanoma. Different shades of brown, tan, black, red, white, or blue may be seen. 
• D- Diameter: melanomas usually are larger than ¼ inch or 6 mm, however they can be smaller when detected early. 
• E- Evolving: a mole that changes, or evolves, over time is a warning sign for melanoma. Any change in size, shape, color, elevation or begins to bleed, itch, or crust should be examined more closely by a dermatologist. 

Diagnosis

To determine if a person has melanoma, the physician will ask questions about family history and symptoms and perform a head-to-toe skin exam. We use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Biopsy: Part or all of a mole, growth or pigmented area of the skin can be removed with a small tool or a fine needle, and a sample of the tissue is analyzed in a laboratory for cancer. 

Determining melanoma thickness and mitotic rate: If melanoma is found on a biopsy, the tissue sample is examined further to measure how thick it is. In addition, the pathologist examining the tissue will examine the cells’ mitotic rate, or the portion of cells that are dividing. Measuring these can help determine how advanced the cancer is. 

Testing for gene changes: in people with advanced melanoma, the cells in the biopsy sample will be tested for the presence of mutations in certain genes. Detecting the presence of mutations can help determine treatment options. 

Sentinel node biopsy: To determine if melanoma has spread to nearby lymph nodes, a sentinel node biopsy may be recommended. During this procedure, a dye is injected near the site where the melanoma was removed. The dye helps locate the closest lymph node to the melanoma. Once the lymph node is located, a small incision is made in the skin and the lymph node is removed and examined for cancer cells. If cancer cells are found, additional lymph nodes may be removed and examined.

Imaging tests: A chest X-ray, CT scan, MRI or PET scan may be used to look for the possible spread of melanoma to lymph nodes and other areas of the body. 

Risk Factors

In most cases, the cause of melanoma is unknown. Risk factors that can contribute to the development of melanoma include:
 

Age: Melanoma is more likely to occur in older people. However, melanoma is one of the most common cancers diagnosed in people younger than 30, particularly in women. 

Fair skin, freckling, and light hair: Light skin contains less pigment for protection from harmful UV radiation that can cause melanoma. Persons with white skin, red or blond hair, blue or green eyes, or fair skin that freckles or burns easily are at increased risk. 

Gender: More men are diagnosed with melanoma than women, however this varies by age. Before age 50, the risk is higher in women. After age 50 the risk is higher in men.

Genetics and family history: Carrying the genes CDKN2A and CDK4 or having close family members who had melanoma increase the risk for getting melanoma.

Having many moles or unusual moles: Having 50 or more moles or moles that are an unusual shape, raise the risk for melanoma.

History of sunburns: Having one or more blistering sunburns can raise the risk for melanoma.

Overexposure to ultraviolet (UV) light: Being exposed often to the sun and using tanning beds or lights increase the risk for getting melanoma.

Personal history of skin cancer: Persons who have already been diagnosed with skin cancer are at an increased risk of developing melanoma. 

Weakened immune system: The immune system helps fight cancers of the skin. Therefore, people who have weak immune system face a higher risk of melanoma and other skin cancers.

Prevention

While some risk factors like age and heredity cannot be controlled, there are ways to lower the chance of getting melanoma:

Examine your skin regularly: Have regular skin exams by a dermatologist. Check the skin covering your whole body monthly for changes in moles, freckles, marks or growths. See a physician if they change or appear abnormal.

Limit sun exposure: Try to avoid the sun’s harmful UV rays from 10 a.m. to 4 p.m., when they are the strongest.

Wear protective clothing: When you are out in the sun, wear a wide-brimmed hat, dark clothing and sunglasses for protection.

Wear sunscreen with an SPF of 30: Use sunscreen daily because UV rays can cause sunburn on cloudy days and also during colder months. Reapply sunscreen every two hours or more often if you’re swimming or sweating. 

Avoid artificial UV rays: Avoid artificial UV rays such as those found in tanning beds. 

Prognosis

The prognosis for melanoma depends upon how early the cancer is diagnosed, how far it has progressed and the size of the tumor. The highest survival rate for melanoma occurs for people diagnosed and treated early. 

Treatment and Recovery

Treatment for melanoma depends upon the stage, size and location of the tumor.

Surgery

Surgery is the main treatment for melanoma. For early-stage melanoma, a thin layer of skin can be removed during a biopsy, requiring no further treatment. Or, a physician may remove the cancer and a layer of tissue beneath it, which may also be the only treatment needed.

If melanoma has spread to the lymph nodes, treatment may include surgery to remove lymph nodes and tumors, and possibly, chemotherapy, radiation therapy, biological therapy and targeted therapy.

Chemotherapy

Chemotherapy uses special drugs designed to kill cancer cells. The treatments can be given as a pill or injected into the bloodstream. Chemotherapy can be administered before surgery to make the tumor smaller or after surgery to keep cancer from reoccurring. 

Radiation Therapy

High-energy X-rays are used to kill melanoma cells. Treatments can be given before surgery to shrink tumors or after surgery to reduce the risk of cancer returning. In some cases, radiation therapy is used to relieve symptoms when melanoma has spread to other areas of the body. 

Biological Therapy

Biologic therapy, or immunotherapy, are substances made by the body or in a laboratory given to strengthen the immune system to help fight melanoma.

Targeted Therapy

Targeted therapy can include a combination of oral and intravenous (injected into the vein) drugs or other substances, to attack the way melanoma cells develop, multiply and interact with other cells. 

Clinical Trial 

Clinical trials test new ways to treat cancer and manage its symptoms.

Complications

Melanoma can return after treatment and can spread to other parts of the body, so follow-up care after successful treatment is important. In addition, the cancer itself and some treatments can result in complications, depending on the type and stage of the cancer. Common complications may include:Scarring: Surgery to remove melanoma can produces a scar.

Lymphedema: Treatment can cause damage to the lymph system, which can slow the movement of lymph fluid through the body. This can cause the fluid to build up in the tissues and result in swelling, usually in the arm or leg.