1. What is melanoma?
Malignant melanoma is the result of an abnormal growth of melanocytes, the cells that produce melanin, the pigment giving color to the skin. Unlike more common skin cancers, such as basal cell and squamous cell carcinoma, melanoma can spread to other organs, making treatment more challenging. Although rare, melanoma can originate in pigmented tissues other than the skin: in the eye, for example, or in an internal organ. Melanoma that appears on the skin is called cutaneous melanoma.
2. How common is melanoma?
According to the National Cancer Institute, the percentage of people who develop melanoma has more than doubled in the United States over the past 30 years. Melanoma is the sixth most common type of new cancer diagnosis in American men and the seventh most common type in American women. The incidence rate for invasive melanoma, the most serious form, is highest in whites, who are almost 30 times more likely to develop melanoma than African Americans. Hispanics are also at a much lower risk of developing the disease than are whites. Men aged 65 or older are more than twice as likely to develop melanoma as women in the same age group.
3. Where does melanoma usually appear on the body?
For people with moles, any mole anywhere on the body has the potential to develop into melanoma, which is why regular monitoring of these growths is important. Usually, in fair-skinned women, melanoma appears most frequently on the lower legs or arms. In fair-skinned men, melanoma appears more frequently on the trunk or on the head and neck. In individuals with darker skin, melanoma tends to appear more often on the palms, the soles of the feet and the skin under the nails.
4. What are the risk factors for melanoma?
Exposure to ultraviolet radiation (UV) is the only known environmental risk factor for developing melanoma of the skin.
5. What are the signs and symptoms of melanoma?
Moles (benign growths of melanocytes) are far more common than melanomas, and differentiating between these can be difficult, even for experts. Any growth on the skin that is new or changing is best evaluated by your health-care provider. Additionally, itching (pruritus) of a new or existing mole, ulceration or bleeding from a mole can be early symptoms of melanoma.
The following "ABCDE" guidelines can help determine the need for additional evaluation:
6. I have a lot of moles. Am I at higher risk of developing melanoma?
Yes. It is important to watch for any changes in the appearance of these moles, called either benign nevi or atypical nevi, by your health care provider. Medical researchers estimate that persons with more than 100 nevi have a seven-fold greater risk of developing melanoma than those with fewer nevi. Patients with five or more atypical nevi have a seven-fold risk for melanoma compared to those with no atypical nevi. Having multiple moles or nevi is a higher risk factor for melanoma than having light-colored hair and fair skin.
7. Are there different types of melanoma?
Yes and some are more common than others. The most common form is called superficial spreading melanoma.
8. How is melanoma diagnosed?
A definitive diagnosis of melanoma is made with an excisional biopsy that removes the mole and a margin of tissue surrounding it, or with a "punch" biopsy of the thickest part of the mole if it is large or in a difficult anatomical area to reach. These biopsies are outpatient procedures performed in your doctor's office. A pathologist will look at the sample under a microscope and determine if the cells are cancerous. The biopsy sample allows the pathologist to determine the stage of disease, upon which treatment decisions are then made.
9. What are the stages for melanoma?
Staging is a method clinicians use to categorize melanomas for the purpose of evaluation, treatment and prognosis. Virginia Mason uses the staging system developed by the American Joint Commission on Cancer (AJCC) that assigns categories based on tumor (T), lymph node (N) and metastatic (M) status. Melanomas are also assigned an anatomic level or "Clark's level" I to IV as a description of tumor depth into the skin.
In addition, staging of cancer may include the following descriptions:
10. What is the treatment for melanoma?
Melanoma treatment decisions are based on the location and stage of the tumor, and factors specific to the individual patient. At Virginia Mason, a dedicated treatment team may include dermatologists, surgeons, medical oncologists, radiation oncologists, pathologists, radiologists and nurses. A treatment plan may include:
11. Is melanoma curable?
Like many other cancers, melanoma is potentially curable when caught at an early stage. Once you have had melanoma, however, you are at a higher risk than the general population of developing a new primary melanoma, as well as a recurrence of the original melanoma. This is why it is important for you to have regular check-ups that include lifelong surveillance from your health care providers.
12. What treatment outcomes can I expect based on the stage of cancer I have?
As is true for many types of cancer, melanoma diagnosed and treated at its earliest stages - when the disease has not spread to lymph nodes or distant sites in the body - has the best chance of a cure. Five and 10-year survival rates for early-stage disease approach 90 percent and higher. Those survival rates gradually go down, however, in the presence of more advanced disease. Your health care providers are best positioned to answer your questions based on the stage of melanoma you have.
13. Will my melanoma recur?
Questions about recurrence are commonly asked by cancer survivors. For patients with melanoma, the risk of developing a second primary melanoma is higher than the risk of people in the general population developing a first melanoma. Patients with melanoma are also at risk of recurrence of their original cancer. Second primary melanomas develop at a rate of approximately 0.5 percent per year for the first five years and at a lower rate thereafter. The incidence of a second primary tumor is especially high in patients aged 15 to 39 or 65 to 79. For these reasons, patients are generally followed closely by their dermatologist and oncologist after the initial treatment for cancer.
The most common site of recurrence of the first cancer is in the regional lymph nodes (46 percent), followed by recurrence at or near the original tumor site (30 percent), and at distant sites (24 percent). Current follow-up recommendations include at least annual, lifelong comprehensive skin examinations for all melanoma patients, including those with stage 0 disease (melanoma in situ). Patients with more advanced disease should have more frequent exams and imaging (X-ray, CT scan) studies. As with primary melanoma diagnoses, more than 70 percent of melanoma recurrences are detected by the patient or a family member.
14. Since I have melanoma, do members of my family need to be tested?
There are genetic variants - gene mutations - that make some individuals prone to developing melanoma. These mutations occur in the genes CDKN2A and CDK4 that code for proteins regulating cell division. Individuals with these mutations have a strong family history of melanoma and carry a 60 to 90 percent lifetime risk of developing the disease. Virginia Mason offers a hereditary cancer risk assessment for cancer patients with an extensive personal or family history of cancer.