Melanoma Treatment

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Melanoma Treatment

What is melanoma?

Melanoma is one type of skin cancer. Although it is rare, melanoma is the deadliest type. It’s much more likely to spread to other parts of the body. It usually begins with changes in an existing mole or the growth of a new mole. Melanoma skin cancer develops when the skin cells that produce the pigment that gives skin its color (melanocytes) begin to grow out of control. Melanoma that starts in the skin is called cutaneous melanoma. It can also develop in the eyes and on mucous membranes in the nose, mouth, throat or genital area. 

While the cause is unknown, ultraviolet radiation from the sun or tanning beds greatly increases the risk of developing melanoma. If found early, melanoma can be treated successfully. It’s initially treated with surgery. Chemotherapy, radiation, and targeted therapies may be added to the treatment plan.

Why should I worry about melanoma?

Although melanoma is rare, it is the most serious skin cancer. It can be fatal if diagnosed at an advanced stage.

Causes

What causes melanoma?

Melanoma occurs when cells develop DNA damage and grow out of control, forming a mass of cancer cells called a tumor. It is not known what causes the DNA damage or why it causes melanoma. It is likely that both environmental (ultraviolet {UV} radiation from the sun) and genetic factors cause it. 

Skin cancer begins in the outer layer of skin called the epidermis. Three types of cells (squamous, basil and melanocyte cells) make up the top layer of the epidermis. Melanoma begins in the melanocyte cells that also produce skin color (melanin). 

Melanoma and nonmelanoma are the two types of skin cancer. Nonmelanoma skin cancers are basal cell carcinoma and squamous cell carcinoma. Nonmelanoma cancers rarely spread to other parts of the body, and are far more common than melanoma.

Who’s at risk for melanoma?

People who have one or more of these characteristics have a higher chance of developing melanoma:

  • Light skin, which has less pigment, provides less protection against UV rays. Blonde or red hair, blue or green eyes, and a tendency to freckle or sunburn easily increase your risk. However, people with darker skin can get melanoma. They are more likely to get melanomas under their fingernails, palms and soles. 
  • Having more than 50 moles, or unusual moles that are large or have irregular borders and are multi-colored.
  • One or more severe sunburns, especially as a child
  • Family history of melanoma
  • Weakened immune system from a disease (HIV AIDS) or an organ transplant that requires medication to suppress the immune system. 
  • Living close to the equator or at a high elevation exposes skin to higher amounts of UV radiation
  • Exposure to chemicals such as vinyl chloride, solvents and PCBs

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Symptoms

What are the symptoms of melanoma?

On the skin, melanomas can develop anywhere, but they’re most common in areas exposed to the sun. Moles are a common sight, but melanoma can also develop on normal, blemish-free skin. 

Moles that become cancerous can have these symptoms:

  • Asymmetry means the shape is irregular, and one half doesn’t match the other half
  • Borders are irregular, notched, scalloped or blurred
  • Color is uneven but usually brown or black; some melanomas don’t produce melanin and may be pink, tan or white
  • Diameter or size changes, usually growing larger
  • Evolving or changing over time in terms of color, size, shape or feel
  • Location is most likely to be the chest or back in men; on the arms and legs in women; neck and face are also common 
  • Irritation or itching
  • Oozing or bleeding, or a hole forms on the skin (ulceration)
  • New moles grow near existing moles 

Melanomas on mucous membranes, called “hidden” melanomas, can develop in places not exposed to UV radiation. This type of melanoma is much less common. Hidden melanomas can affect mucous membranes that line the nose, mouth, esophagus, anus, urinary tract and vagina. If melanoma affects the eyes (ocular melanoma), it can cause vision changes. People with darker skin are more likely to have a melanoma under fingernails/toenails, between toes, palms, soles, scalp or genitals.

Diagnosis

How is melanoma diagnosed?

Melanoma diagnosis includes:

  • Your doctor, dermatologist or oncologist will do a physical exam.
  • A sample of tissue is taken for a biopsy.
  • After diagnosis, the melanoma stage will be determined. Staging determines how advanced it is, and helps your medical team determine the best treatment plan for your needs. 
  • Melanomas are staged using 0 through IV. Stages 0 and I mean the melanoma is small and can likely be treated successfully. The higher the stage, the lower the chances of curing it. At stage IV it has spread to other internal organs. 
  • The thickness of the melanoma is measured to help determine the stage and specific treatment. The thicker the tumor, the more serious it is, and may indicate if it has spread to other parts of your body (metastasized). For example, thinner tumors may only need surgery to remove cancer and some normal tissue around it. Thicker tumors will require further testing to determine if and where it’s spread. If it’s spread to the lymph nodes, you may need a sentinel node biopsy. This requires dye to be injected into the area, which flows to nearby lymph nodes. The first lymph nodes that receive the dye are removed and tested for cancer. If they’re cancer-free, it’s not likely the melanoma has spread.
  • Advanced melanomas and those that have spread require imaging tests such as X-rays, CT scans or PET scans.

Treatment

What are the treatment options for melanoma?

Treatment is determined by the size and stage of the melanoma, age and overall health, and personal preferences. 

  • A biopsy may be used for small and very thin melanomas that can be removed completely during the biopsy. No further treatment is needed. 
  • Surgery works well for small melanomas, by removing the tumor and a thin margin of healthy tissue immediately around it and beneath the skin. This may be all the treatment needed for early-stage melanomas.
  • Surgery, plus additional treatments before or after surgery, will be used to remove nearby lymph nodes if needed. 
  • Immunotherapy, or biologic therapy, uses medications to boost your immune system to help it more effectively fight cancer. It is often used after melanoma surgery to remove lymph nodes, or if it has spread to other areas. Immunotherapy drugs can be injected into the melanoma in cases where it can’t be fully removed during surgery.
  • Targeted therapy can cause cancer cells to die without harming healthy tissue. It may be recommended if the melanoma has metastasized. 
  • Radiation therapy can be used to kill cancer cells and target the lymph nodes. It’s also used to treat melanomas that cannot be completely removed with surgery. If the cancer is advanced, radiation can relieve symptoms.
  • Chemotherapy uses medications, given intravenously or by mouth, to kill cancer cells.

Prevention should be an important part of your treatment because you have a higher risk of skin cancer. Risk can be reduced if you:

  • Avoid the sun during the middle of the day, between 10 a.m. and 4 p.m., even on cloudy days and during the winter months. Even without sunburns, accumulated sun exposure over years can also cause melanoma. 
  • Avoid tanning beds and sunlamps. They are just as dangerous as the sun.
  • Apply sunscreen (with an SPF of 30) before all sun exposure, regardless of the time of year. Reapply every two hours, and more often if you’re sweating or swimming.
  • Wear protective clothing that covers your skin, a wide-brimmed hat (not a baseball cap or visor) and sunglasses that block UVA and UVB radiation.
  • Inspect your skin regularly so you’ll notice if it changes.

References

American Cancer Society. (Aug. 2019). What is Melanoma Skin Cancer? Retrieved 9-23-21,    {https://www.cancer.org/cancer/melanoma-skin-cancer/about/what-is-melanoma.html}
Mayo Clinic. (March 2020). Melanoma. Retrieved 9-23-21, {https://www.mayoclinic.org/diseases-conditions/melanoma/symptoms-causes/syc-20374884}
Mayo Clinic. (March 2020). Melanoma: Diagnosis and Treatment. Retrieved 9-23-21, {https://www.mayoclinic.org/diseases-conditions/melanoma/diagnosis-treatment/drc-20374888}
Medline Plus. (n.d.). Melanoma. Retrieved 9-23-21, {https://medlineplus.gov/melanoma.html}
National Cancer Institute. (n.d.). Melanoma Treatment. Retrieved 9-23-21, {https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq#_135}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Initial Visit

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Follow Up
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