Melanoma: Warning Signs and Treatment
What is melanoma?
Melanoma is a serious type of skin cancer. It is deadly and can spread (metastasize) to other parts of the body.
It most commonly occurs in sun-exposed areas like the face, top of the arms, legs, and back, but can occur anywhere on the skin. For men, the most common location is the back and for women, it is the back of the leg.
Melanoma can also occur in non-sun exposed areas like the genitals, palms or soles, or under the nails. Melanoma on the palms of the hands, soles of the feet, or nails are more common in people with darker skin.
Usually, melanomas can look like moles—but they tend to be odd-shaped, grow, and change quickly. Getting diagnosed and treated early is very important. Treatment is typically removing the melanoma. Though melanoma can be fatal, melanoma makes up a small amount of all skin cancers in the U.S.—just 1%.
What does melanoma look like?
Having one melanoma increases your risk of another melanoma—regular skin exams by a dermatologist are necessary. So are self skin checks! Monitor your skin for new moles or changing moles. Follow the ABCDEs of melanoma detection. If anything concerns you, call your doctor or dermatologist. —Dr. Lauren Levy
A melanoma can appear anywhere on your body and look like a basic mole for months or even years. The existing mole might get bigger, change shape or color, or bleed. If a mole looks noticeably different from other moles on your body, that’s a concern.
Sometimes a mole can “evolve” to take on an irregular appearance as well. A mole that stands out as different from other moles may also be a clue. This is referred to as the “ugly duckling” sign.
Often melanomas can be mistaken for moles or other skin growths such as seborrheic keratoses (non-cancerous warty growths that are more common with age).
Early detection and treating of melanomas can increase your survival rate. Look for these early signs—the ABCDEs of potential melanoma:
- A is for asymmetry. That means it’s uneven, not a perfect circle or oval.
- B is for border irregularity. The edges of the melanoma don't look sharp or crisp. It might have a wavy, notched, or blurred edge.
- C is for color variation. It’s not normal brown like your usual moles. It might even be more than one color.
- D is for diameter. A melanoma is usually bigger than 6 mm (about ¼-inch) across.
- E for evolution. This is the most important sign. The mole changes in size, shape, color. Melanoma can grow very quickly. It can become life-threatening in as little as 6 weeks.
What causes melanoma?
Melanocytes are special cells that make color (pigment) to protect your skin. The sun’s ultraviolet (UV) rays can make melanocytes change into cancerous cells. These cancerous melanocytes can grow in number, completely unchecked. They then make excess pigment, which leads to the odd appearance of melanomas.
Melanocytes move about freely in the skin unlike other skin cells, which are anchored to each other. This is dangerous because they can carry cancer cells to other organs very quickly.
You’re more likely to develop melanoma if you:
- Have spent a lot of time in the sun. Or spend smaller amounts of time in really strong sunshine.
- Have had numerous sunburns in your life. (Just five sunburns doubles your risk.)
- Are fair-skinned.
- Use tanning beds.
- Have a family history of skin cancer.
- Have more than 50 moles on your body.
- Have a history of abnormal moles or melanomas.
- Are over 40 years old.
Treatments for melanoma
In the past several years, newer therapies (immunotherapies) have revolutionized the treatment of advanced stage melanoma and increased survival rate. The medications can lead to remission (i.e., cure) of the disease in some people. These are not traditional chemotherapies but medications that trick the immune system into attacking the melanoma cells. —Dr. Levy
Surgery is the usual treatment. If the tumor is early-stage, surgery alone might be enough to remove the cancer. But for bigger tumors, more treatment may be necessary.
Your dermatologist (a doctor who specializes in skin health) will make recommendations based on your history and tests. Options beyond surgery may include medications (immunotherapy or chemotherapy medicines) and radiation.
For smaller melanomas, surgery can be done with injecting numbing medication. For larger melanomas, you may need general anesthesia. Sometimes, if the area that is cut out is too large or difficult to stitch back together, a skin graft may be needed.
After surgery, the area is dressed with gauze and bandages. There can be some mild bleeding and mild pain for several days after the surgery. Healing will take several weeks. Your surgeon will see you several weeks after the surgery to follow up on the healing and to remove the stitches.
If the melanoma is advanced or in a later stage, your doctor may recommend a lymph node biopsy. This is done in the operating room by a specialized doctor. During this procedure, the doctor samples the lymph node to see if there are any cancer cells present. If there are, the lymph nodes may be removed.
For a melanoma on your face that hasn’t spread, your doctor might suggest Mohs Micrographic Surgery. This is a multi-step procedure that slowly removes layers of the skin and tests the layers in the laboratory to make sure all cancerous cells are gone while leaving as much healthy skin as possible. The process is typically quite time-consuming but lowers the chance of bad scarring.
If the melanoma has spread to other organs, you’ll need immunotherapy after surgery. These medications prompt your immune system to find and kill cancer cells. This helps slow the spread. (Chemotherapy may be used when immunotherapy stops working.)
If melanoma has spread to the brain or other organs, tumors will grow. Radiation therapy can help kill cancer cells and control tumor growth. This can help prevent symptoms. But it is not a cure.
Melanoma in children
Kids usually don’t get melanomas. But when they do, it looks different. If your child has a weird mole, check for the children’s ABCD’s of melanoma:
- A - Amelanotic (does not contain melanin so appears red or pink)
- B - Bleeding or it’s a bump
- C - Multi-colored
- D - “De novo,” which means it is a new mole
If any of these apply to a mole on your child, tell the pediatrician. They might want you to see a dermatologist.
Tanning beds are dangerous. The use of a tanning bed can increase your risk of melanoma by 35. That’s huge! —Dr. Levy
If you notice a new mole or changes in an old one, see your dermatologist. They will ask you questions about the mole and examine it carefully. They may use a special light called a dermatoscope that allows them to see structures that are not visible with the naked eye.
They may give you a local anesthetic and take a sample of the mole (called a biopsy). If lab work confirms melanoma, the dermatologist will decide on the course based on how deep the melanoma is on the biopsy that was taken.
For the first 2 to 3 years after surgery, get a skin check every 3 to 6 months. If no melanomas are found after 5 years, cut back to a skin check every 6 to 12 months. The specific timetable will depend on how many moles you have and your risk factors. Call your doctor if you notice any new moles that don’t look normal or new moles around where the melanoma was removed.
- Be sun smart, avoiding the sun between 10 am and 4 pm.
- Use sunscreen that is SPF 30 or higher.
- Wear long sleeve shirts and pants when you’re outside.
- Stay in the shade whenever you can.
- Never use indoor tanning beds.
- Contact your doctor if you notice any new, changing, or odd moles.
- Get a yearly skin check if you are high risk and/or have a family history of melanoma.
Dr. Bae is a native Californian who obtained his BA in Molecular and Cell Biology from the University of California, Berkeley and obtained his MD from Boston University School of Medicine. He is currently training in Dermatology as a resident physician at Brown University / Rhode Island Hospital.
When he's not in clinic he enjoys cooking, tennis, weight lifting and strategic board games.