Charlotte, NC
Dipendra Kandel, MD
Melanoma is a type of skin cancer that is derived from melanocytes. Melanocytes are special skin cells that secrete melanin, the dark pigment responsible for giving the skin its characteristic color.
Melanoma is less common in general populations when compared to other forms of skin cancers, but it is common in white populations. However, melanoma is dangerous, particularly because of its ability to quickly spread to other parts of the body. Fair-skinned and light-haired people with high UV exposure are at increased risk of developing melanoma.
Melanoma has been linked to several potential causes, such as:
If someone in your family, like a parent or sibling, has had melanoma, you’re more likely to get it too. 5 to 10% of the cases of melanoma are known to have a family history, and if you have one family member with melanoma then you are 2.2 times more likely than general people to get it.
Blue eyes, red or blonde hair, fair skin tone, history of sunburns, and freckles are known high-risk factors for causing melanoma.
Lifetime sun exposure is a key risk factor for melanoma, as the more time your skin is exposed to the sun, the more UV radiation it absorbs, leading to cumulative damage. Each time your skin is in the sun without protection, the UV rays can harm the DNA in your skin cells. Over the years, even without frequent sunburns, small, repeated exposures—like tanning or spending time outdoors without sunscreen add up, increasing your risk.
If you live in places closer to the equator or at higher elevations, you’re exposed to stronger UV rays, which increases your risk of developing melanoma. At higher altitudes, the air is thinner, so UV rays can penetrate more easily, and near the equator, the sun’s rays are more direct.
If you have a lot of moles or unusual-looking moles, your risk of melanoma goes up. Changes in shape, size, or the color of the moles are considered risks for having melanoma.
At the time of diagnosis, a lower socioeconomic position may be associated with a more advanced condition. Patients of low socioeconomic class perceive a lower risk of melanoma, are less knowledgeable about the disease, and follow fewer preventative measures.
Melanoma can appear on any area of the body. Melanomas are more common on the trunk in cases of males and on lower limbs in cases of females. Melanoma can present over the skin in many different ways. The typical signs of melanoma are often described by the ABCDE mnemonic. The ABCDEs of melanoma include:
One half of the mole or skin spot doesn’t match the other half. If you draw a line through the middle of a mole, both sides should look the same. In melanoma, one-half is often uneven or irregular in shape.
Melanomas tend to have irregular, scalloped, or poorly defined edges. If the borders of your mole are jagged or blurred, it’s something to watch out for, as healthy moles usually have smooth and clear borders.
Normal moles are usually a single shade of brown or black. Melanomas often have a variety of colors, including different shades of brown, black, tan, or even red, blue, or white. A mole with multiple colors or unusual tones is a warning sign.
Melanomas are often larger than 6 millimeters in diameter (about the size of a pencil eraser), although they can be smaller when first detected.
Look out for any mole that changes over time, whether in size, shape, color, or elevation—or any new symptoms like bleeding, itching, or crusting. Evolution is a key sign that something may be wrong.
Other Warning Signs
If a mole or spot becomes painful, itchy, or tender, it may indicate a problem. Bleeding, oozing, or crusting from a mole is also a red flag, as healthy moles don’t typically do this. Another sign is any new growth or mole that suddenly appears on your skin, especially if it looks unusual. Also, pay attention to changes in texture; if a mole becomes rough, scaly, or raised, it could be a sign of melanoma.
Examining the area of skin under question is the most important aspect of diagnosing melanoma.
Dermatoscopy is a non-invasive tool doctors use to examine your skin more closely. It’s like a special magnifying glass that helps your doctor see deeper into a mole or spot, looking for patterns, colors, and other details that aren’t visible to the naked eye. This tool helps in deciding whether a mole might be melanoma.
Skin biopsy and histopathology are the key steps to confirm melanoma. If your doctor suspects melanoma after examining your skin, they’ll remove a small part (or all) of the mole in a biopsy. This sample is sent to a lab where specialists look at the cells under a microscope to check if they are cancerous. This is the most definitive way to diagnose melanoma.
These tests might be used if there’s a concern that melanoma has spread to other parts of your body. Common imaging techniques include ultrasound, which uses sound waves to create images of soft tissues; CT scans, which provide detailed cross-sectional images of the body; and MRIs, which use magnetic fields to create detailed images of organs and tissues. These scans help doctors check if the cancer has affected organs like your lymph nodes, lungs, or liver.
Treating involves several strategies depending on the stage and location of the cancer and patient-specific factors. These treatment options vary depending on the stage and specific characteristics of the disease. Various treatment options involve:
Surgery is the primary treatment for early-stage melanoma. During this procedure, the surgeon removes the melanoma along with a margin of healthy skin surrounding it to ensure the complete removal of cancerous cells. If the melanoma is thicker or has spread to nearby lymph nodes, a wider excision may be necessary. Sometimes, a sentinel lymph node biopsy is performed to check if the cancer has spread. This involves removing and examining the nearest lymph node to the melanoma. Successful surgical intervention can lead to excellent outcomes, especially when the melanoma is diagnosed at an early stage.
Immunotherapy enhances the body’s natural immune response to recognize and fight melanoma cells. One of the most common types of immunotherapy is checkpoint inhibitors, which help to remove the “brakes” on the immune system, allowing it to attack cancer more effectively. Drugs such as pembrolizumab and nivolumab have shown significant success in treating advanced melanoma. Patients often experience durable responses, meaning that the benefits can last for a long time, even after treatment has stopped.
This therapy focuses on specific genetic mutations that are present in melanoma cells. For instance, many melanomas have mutations in the BRAF gene, making them susceptible to drugs like vemurafenib and dabrafenib, which specifically target and inhibit the growth of these mutated cells. Targeted therapy is particularly beneficial for patients with advanced melanoma and can be combined with other treatments to enhance efficacy.
Chemotherapy involves the use of powerful drugs to kill rapidly dividing cells, including cancer cells. Although it is less commonly used for melanoma today due to the effectiveness of immunotherapy and targeted therapy, chemotherapy can still play a role in certain cases, particularly when the cancer has spread significantly. While chemotherapy can be effective, it may also come with significant side effects.
Radiation therapy utilizes high-energy rays to target and destroy cancer cells, often used when surgery isn’t an option or to treat areas of the body where melanoma has recurred. This treatment can help shrink tumors or relieve pain caused by advanced melanoma. Radiation may be used as an adjunct therapy after surgery to eliminate remaining cancer cells, thereby reducing the risk of recurrence. Patients undergoing radiation therapy typically receive several sessions over a set period, and the side effects can vary, but many find that it effectively helps manage their disease.
The prognosis of melanoma depends primarily on the stage at diagnosis. Early-stage melanomas have a favorable prognosis, with five-year survival rates exceeding 90%. Prognosis worsens with regional spread and is poor for distant metastasis, though advancements in immunotherapy and targeted therapy have improved outcomes in advanced cases.
Other factors influencing prognosis include tumor thickness and ulceration. Younger patients and females generally have a better prognosis than older patients and males. Overall, health and genetic factors have a role in prognosis. Similarly, the effectiveness of initial and subsequent treatments greatly influences the prognosis. Patients responding well to therapies such as immunotherapy or targeted therapy often experience prolonged survival and improved quality of life.
Here are four effective strategies for melanoma prevention:
Protecting your skin from the sun is crucial. When outdoors, use sunscreen with at least SPF 30, applying it generously and reapplying every two hours, especially after swimming or sweating. Wearing protective clothing, such as long sleeves and wide-brimmed hats, can also shield your skin from harmful UV rays. Additionally, seek shade during peak sun hours, typically between 10 AM and 4 PM, when the sun’s rays are the strongest.
Tanning beds can expose your skin to high levels of UV radiation, increasing your risk of developing melanoma and other skin cancers.
Performing regular self-examinations of your skin can help you spot any new or changing moles or spots early on. Familiarize yourself with the appearance of your moles and look for any changes in size, shape, color, or texture.
Being aware of the factors that increase your risk for melanoma, such as a family history of skin cancer, having many moles, or a history of sunburns, can help you take preventive measures.
