ABOUT MELANOMA

Melanoma is usually, but not always, a cancer of the skin. It begins in melanocytes – the cells that produce the pigment melanin that colors the skin, hair and eyes. Melanocytes also form moles, where melanoma often develops. Having moles can be a risk factor for melanoma, but it’s important to remember that most moles do not become melanoma. 

WHAT IS MELANOMA?

 

There are three general categories of melanoma:

  • Mucosal Melanoma can occur in any mucous membrane of the body, including the nasal passages, the throat, the vagina, the anus, or in the mouth

  • Ocular Melanoma, also known as uveal melanoma or choroidal melanoma, is a rare form of melanoma that occurs in the eye. Learn more about CURE OM, the MRF’s initiative focused on ocular melanoma

Unlike other cancers, melanoma can often be seen on the skin, making it easier to detect in its early stages. If left undetected, however, melanoma can spread to distant sites or distant organs. Once melanoma has spread to other parts of the body (known as stage IV), it is referred to as metastatic melanoma, and is very difficult to treat. In its later stages, melanoma most commonly spreads to the liver, lungs, bones and brain; at this point, the prognosis is very poor.

What Causes Melanoma?

Research suggests that approximately 90% of melanoma cases can be linked to exposure to ultraviolet (UV) rays from natural or artificial sources, such as sunlight and indoor tanning beds. However, since melanoma can occur in all melanocytes throughout the body, even those that are never exposed to the sun, UV light cannot be solely responsible for a diagnosis, especially mucosal and ocular melanoma cases. Current research points to a combination of family history, genetics and environmental factors that are also to blame. Taking steps to prevent melanoma is therefore the best first step in protecting yourself and your skin. It is important to learn about all of the risk factors. Learn more about how to prevent melanoma by clicking on the link below!

RISK FACTORS

You may be at a higher risk for developing melanoma if you have at least 5 of the criteria below. Talk to family members and your doctor about whether you are at an increased risk and the steps you can take to prevent melanoma. Melanoma is the leading cause of cancer death in women 25 to 30 years old and the second leading cause of cancer death in women 30 to 35 years old.

  • Fair skin, light hair color, light eye color: Light skin, blonde or red hair, and blue eyes provide less protection against damaging UV rays; however, having dark skin, hair and eyes does not eliminate your risk

    • Individuals with red hair​ have a risk 3x higher than the average population.

  • Tanning bed use: Tanning bed use before the age of 30 increases your risk of melanoma by 75 percent. Learn more about why tanning is dangerous.

  • Exposure to UV radiation: Whether it’s from natural or artificial sources, limiting your UV exposure will help decrease your risk of getting melanoma

  • Family history of melanoma: If one or more of your immediate family members has been diagnosed, this increases your chance of a diagnosis. The closer the relative, the higher your chances.   

  • Sunburns at a young age: Just one blistering sunburn at a young age doubles your chances of a diagnosis

  • High number of moles: Individuals with 50+ moles have an increased risk

  • Atypical moles: Individuals with 2 or more abnormal or atypical-looking moles have an increased risk. Learn more about what atypical moles look like here.

  • Previous melanoma diagnosis: A previous diagnosis increases your risk of a recurrence

  • Weakened immune system: Certain cancers and illnesses that weaken your immune system can place you at an increased risk

  • Previous non-melanoma skin cancer diagnosis: If you have been diagnosed with basal or squamous cell carcinoma in the past, you are at increased risk

  • Age: Melanoma is most common in men over the age of 50 (more common than colon, prostate and lung cancer). Melanoma is the second most common cancer in teens and young adults and is the most common type of cancer for young adults. 

 

Diagnosis

Most melanoma diagnoses begin with the patient, a loved one, or a doctor noticing a new, abnormal, or changing mole or lesion on the skin. As with many kinds of cancer, early detection and treatment is critical to preventing early stage melanoma from progressing to the more advanced stages. Knowing the ABCDEs of melanoma identification and performing regular self-checks and check‐ups are crucial steps in treatment and prevention. Before an official melanoma diagnosis can be made, however, your doctor will biopsy the lesion and send it to a pathologist who will look at it underneath a microscope to confirm the diagnosis.

Below is a list of the types of biopsies typically done on lesions suspicious for melanoma. 

  • Shave Biopsy: In a shave biopsy, a scalpel or blade is used to remove a thin layer of tissue off of the suspected site. A shave biopsy does not penetrate below the dermis, and results in minimal scarring.

  • Excisional Biopsy: In an excisional (or incisional) biopsy, a larger piece of tissue will be cut away. Compared to a punch biopsy, an excisional biopsy will likely be used when the suspected tumor is thicker or deeper in the tissue. In many cases, an excisional biopsy will be used to completely remove the suspicious area. If it is found to be cancerous, but no additional cancerous cells are found, treatment may be effectively complete after the biopsy.

  • Punch Biopsy: After applying a topical anesthetic the physician uses a small round tool to cut away the piece of skin being sent to biopsy. 

Once the suspected lesion is viewed under the microscope and confirmed to be cancerous, the doctor will proceed by staging the tumor. Cancer staging is the process of determining how much cancer is in the body and where it is located. Staging describes the severity of an individual's cancer based on the magnitude of the original (primary) tumor as well as on the extent cancer has spread in the body. Learn more about how melanoma is staged here.

 

Treatment

Depending on the particular stage of your melanoma diagnosis, there may be several treatment options available to you. Each case is unique - your doctor will want to review your full pathology report and your medical history with you when discussing treatment, to determine the best course of action. And, if you are newly diagnosed with melanoma, learning about treatment options is of the utmost importance. There are many centers around the United States that specialize in diagnosing and treating melanoma. Not sure where to go? Visit the MRF’s Treatment Center Finder to help finding the right place for you.

These are examples of they types of treatment available for melanoma. Based on your personal history, pathology report, and stage at diagnosis, your doctor may recommend one or more of the following:

Surgery is the mainstay of therapy for early stage melanoma and for the resection of an isolated metastatic melanoma site. There are several different types of surgeries that are regularly performed to treat melanoma.

Clinical Trials are research studies to test promising new or experimental cancer treatments. There are hundreds of clinical trials happening at any given time, and most experts agree that for a late-stage diagnosis, clinical trials are the best treatment option. You can also visit our Clinical Trial Finder to learn about clinical trials that are available.

Immunotherapy is a type of systemic therapy used in the treatment of melanoma at high risk for recurrence and metastases. The following immunotherapies are approved by the FDA for the treatment of melanoma: Imlygic (T-VEC), Yervoy + Opdivo, Opdivo (nivolumab), Keytruda (pembrolizumab), Yervoy (ipilimumab), Interleukin-2 (IL-2) and Interferon alpha 2-b.

 

Targeted Therapy is a type of therapy where drugs (or other substances) “target” the abnormal aspects of tumor cells without harming normal cells. Several targeted therapies have been approved for use in treating various cancers, and this approach is now being evaluated in melanoma. You can also use a Targeted Therapy Finder to learn about possible treatment options for you. The following targeted therapies are approved by the FDA for the treatment of melanoma that is positive for the BRAF mutation: Zelboraf + Cotellic (Cobimetinib) , Tafinlar + Mekinist, Tafinlar (dabrafenib), Mekinist (trametinib) and Zelboraf (vemurafenib). 

 

Chemotherapy is a type of systemic therapy intended to destroy melanoma cells throughout the body. Chemotherapy has shown limited success in the treatment of melanoma. Dacarbazine (DTIC) is FDA-approved for Stage IV (metastatic) melanoma. 

Prognosis

Survival rates tell you what portion of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 or 10 years) after they were diagnosed. The survival rate is the percentage of people who live at least a certain amount of time after being diagnosed with cancer. For example, the 5-year survival rate for Stage IIA melanoma is around 81%, this means that about 81% of patients with this tumor stage survive 5 year or longer after their initial diagnosis.

 

Survival rates do not always tell the whole story as they are often based on previous outcomes of large number of people who had the disease, but every patients’ case is different. It’s important to remember that survival rates are based on the cancer stage when it was first diagnosed, and not ones that have returned. They can’t tell you how long you will live, but they may help give you a better understanding about how likely it is that your treatment will be successful. Some people will want to know the survival rates for their cancer, and some people won’t. If you don’t want to know, you don’t have to. 

The table to the right are the survival rates are based on nearly 60,000 patients who were part of the 2008 AJCC Melanoma Staging Database. 

Support

The University of Colorado Hospital (UCH) has some of the top melanoma clinical physicians and researchers in the country. In general, the survival rates of melanoma patients at the UCH are higher than the national and state average. 

Click the link below to get connected to the UCH main website.