Melanoma is often curable with early detection and removal.
What you need to know about melanoma
Melanoma is the least common, but most serious, kind of skin cancer. It begins in the outermost layer of your skin (the epidermis), in the cells that make melanin (melanocytes). It can also start in eyes or other areas with pigment. Melanin gives skin its tan or brown color and helps protect the deeper layers from the sun. Your birthmarks, freckles and age spots are patches of melanin.
New melanoma cases have been rising a little more than 1 percent each year. Survival rates are high. Statistics show that five years after diagnosis, more than 90 percent of people are counted as survivors of melanoma.
Types of melanoma
Melanoma starts when normal melanocytes change and become cancer. When the cancer cells are on the skin, the cancer might be called cutaneous melanoma. Most of what we know about melanoma (its behavior, staging, and treatment) refers to cutaneous melanoma.
Cutaneous melanomas come in these types:
- Superficial spreading melanoma. This is the most common form. It makes up about 70% of all melanomas. These often grow along the skin for a long time before spreading deeper into the skin. They're often flat and have irregular shapes. They may be shades of tan and brown or other colors, like black, white, blue, or red.
- Nodular melanoma. These are often blue-black, dome-shaped sores (lesions). But they can also be pink or red. They tend to grow quickly and deeper into the skin layers.
- Acral lentiginous melanoma. This type is the most common in people with naturally darker skin. These lesions are found on the palms of the hands, soles of the feet, or under a nail (subungual). They often look black or brown.
- Lentigo maligna. These are most common in older people. They're usually flat and large, spreading widely along the surface of the skin. They often begin as non-cancer (benign) lesions on the face or other sun-exposed area. The look a lot like superficial spreading melanoma. When lentigo maligna spreads beyond where it first started or invades deeper into the skin, it's called lentigo maligna melanoma.
- Desmoplastic or neurotropic. These very rare melanomas show up as small nodules on the skin. They are light in color (non-pigmented) and may look like scars. They tend to travel and grow along nerves in the skin. They can also cause fibrous tissue to develop around them.
- Amelanotic melanoma. These rare melanomas are often pink- or flesh-colored. They're different from the more common melanomas because they don’t make pigment. They can be mistaken for a pimple or other noncancer growth. They can be hard to diagnose.
Melanoma cancer growth and spread
Melanoma tends to grow in one of two ways:
- Radial growth. This means the melanoma spreads horizontally along the top layers of your skin. Most melanomas start growing this way. If caught and treated, the risk of spread is low. But over time, it may grow into deeper layers of your skin.
- Vertical growth. This means melanoma grows into deeper layers of skin. This kind of growth is more serious. The melanoma can reach lymph and blood vessels and then spread to other parts of the body. Nodular melanoma grows this way fairly quickly. Still, most melanomas first grow along the top layers of skin for some time.
If left untreated, melanoma tends to spread to other parts of the body more quickly than other types of skin cancer. This can make it more dangerous. This spread can be a bit unpredictable, too.
If you have questions about melanoma, talk with your healthcare provider. They can help you understand more about this cancer
Symptoms of melanoma
The first symptom of melanoma is often a change in a mole, or the appearance of a new mole. The ABCDE rule can help you tell a normal mole from one that might be melanoma. The ABCDE rule is:
- Asymmetry. One half of the mole does not match the other half.
- Border irregularity. The edges of the mole are ragged or irregular.
- Color. The mole has different colors in it. It may be tan, brown, black, red, or other colors. Or it may have areas that seem to have lost color.
- Diameter. The mole is bigger than 6 millimeters across, about the size of a pencil eraser. But some melanomas can be smaller.
- Evolving. A mole changes in size, shape, or color.
Other signs and symptoms that may be melanoma include:
- A mole that itches or is sore.
- A mole that oozes, bleeds, or becomes crusty.
- A mole that looks different from your other moles.
- A sore that doesn't heal.
- A mole or sore becomes red or swells at its edges or beyond.
Become familiar with the way your moles look so you will know if they’re changing. Take note of any new moles that appear on your skin. Most moles are not melanomas, but it is important to see your healthcare provider if you have moles or other spots on your skin with the features above. Also see your provider if you are worried about a spot on your skin for some other reason. Your healthcare provider will examine the mole and do testing on it to find out if you have cancer.
Is melanoma curable?
Melanoma is almost always curable if it’s caught early. However, it can spread through the skin layers and to other parts of the body, which may make treatment more complicated.
Melanoma cancer experts
Legacy Cancer Institute, located in Portland, OR, ranks among the nation’s best cancer programs. We have a team of cancer specialists who work together to diagnose and develop a personalized treatment plan for you. Find the right provider and treatment close to home.
Legacy Cancer Institute is accredited as an integrated network cancer program by the American College of surgeons Commission on Cancer (CoC). Learn more about our quality cancer care.
Next steps after a melanoma diagnosis
Being told you have melanoma cancer can be scary, and you may have many questions. It’s normal to feel afraid. Learning about the cancer and about your treatment options can help you feel less afraid.
At this point, you’ve likely had a physical exam and reviewed your health history with your provider. You may have also had a biopsy to confirm your diagnosis. Following a diagnosis of melanoma, you may have more tests to help your doctor understand your cancer stage.
Cancer staging involves identifying where the cancer is located, if or where it has spread and if it is affecting other parts of your body. Knowing the stage allows your doctor to develop your personalized treatment plan.
Some tests your doctor may now recommend include:
- Blood chemistry studies: Your body’s organs and tissues release substances into your blood which may give clues about your cancer. For melanoma, the blood is checked for an enzyme called lactate dehydrogenase or LDH.
- CT scan, MRI or positron emission tomography (PET): Imaging technology to look inside the body.
- Lymph node mapping or sentinel lymph node biopsy: Radioactive material or blue dye is injected near the tumor. It travels through the lymph ducts to the first node or nodes where cancer is likely to spread. A surgeon removes only those node or nodes and a pathologist tests the tissue for cancer.
- Physical exam and history: After diagnosis, your doctor will conduct an exam to look for lumps or other signs of disease as well as collect your health history.
Customized treatment plans
Because each person and every cancer is different, your doctor uses your tests and exams to come up with an individual treatment plan. How long this takes depends on how complex your case is and your treatment goals. During this time, you build a relationship with your cancer doctors. You become a team for your care.
There are several ways to treat melanoma depending on its location and extent. Options may include surgery, chemotherapy or radiation. Surgery to remove the tumor is the primary treatment for all stages of melanoma. Patients often receive a combination of treatments.
Early-stage (small) melanomas can often be treated with surgery alone.
You are not alone. Legacy offers support throughout your cancer journey, as well as care for your emotional, social and spiritual needs.