Melanoma Treatment

by National Cancer Institute

Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).

Melanocytes are found throughout the lower part of the epidermis. They produce melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes produce more pigment, causing the skin to tan, or darken.

The skin is the body's largest organ. It protects against heat, sunlight, injury, and infection. The skin has 2 main layers: the epidermis (upper or outer layer) and the dermis (lower or inner layer).

When melanoma starts in the skin, the disease is called cutaneous melanoma. This PDQ summary is about cutaneous (skin) melanoma. Melanoma may also occur in the eye and is called intraocular or ocular melanoma. (Refer to the PDQ summary on Intraocular (Eye) Melanoma Treatment 1 for more information.)

There are 3 types of skin cancer:

• Melanoma.
• Basal cell skin cancer.
• Squamous cell skin cancer.

Melanoma can occur anywhere on the body.

In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the arms and legs. Melanoma usually occurs in adults, but it is sometimes found in children and adolescents.

Unusual moles, exposure to sunlight, and health history can affect the risk of developing melanoma.

Risk factors include the following:

• Unusual moles.
• Exposure to natural sunlight.
• Exposure to artificial ultraviolet light (tanning booth).
• Family or personal history of melanoma.
• Being white and older than 20 years.
• Red or blond hair.
• White or light-colored skin and freckles.
• Blue eyes.

Possible signs of melanoma include a change in the appearance of a mole or pigmented area.

These and other symptoms may be caused by melanoma or by other conditions. A doctor should be consulted if any of the following problems occur:

A mole that:

• changes in size, shape, or color.
• has irregular edges or borders.
• is more than 1 color.
• is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).
• itches.
• oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the underlying tissue shows through).

Change in pigmented (colored) skin.

Satellite moles (new moles that grow near an existing mole).

Tests that examine the skin are used to detect (find) and diagnose melanoma.

If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help detect and diagnose melanoma:

Skin examination: A doctor or nurse examines the skin to look for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.

Biopsy: A local excision is done to remove as much of the suspicious mole or lesion as possible. A pathologist then looks at the tissue under a microscope to check for cancer cells. Because melanoma can be hard to diagnose, patients should consider having their biopsy sample checked by a second pathologist.

Suspicious areas should not be shaved off or cauterized (destroyed with a hot instrument, an electrical current, or a caustic substance).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of melanoma (whether cancer is found in the outer layer of skin only, or has spread to the lymph nodes, or to other places in the body
• Whether there was bleeding or ulceration at the primary site.
• The location and size of the tumor.
• The patient's general health.

Although many people are successfully treated, melanoma can recur (come back).

Stages of Melanoma

After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.

The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process:

• Wide local excision
• Lymph node mapping and sentinel lymph node biopsy
• Chest x-ray
• CT scan (CAT scan)
• MRI (magnetic resonance imaging)
• PET scan (positron emission tomography scan)
• Laboratory tests

The results of these tests are viewed together with the results of the tumor biopsy to determine the melanoma stage.

The following stages are used for melanoma:

Stage 0

In stage 0, melanoma is found only in the epidermis (outer layer of the skin). Stage 0 is also called melanoma in situ.

Stage I

Stage I is divided into stages IA and IB.

Stage IA: In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration. The tumor is in the epidermis and upper layer of the dermis.

Stage IB: In stage IB, the tumor is either:

• not more than 1 millimeter thick, with ulceration, and may have spread into the dermis or the tissues below the skin; or
• 1 to 2 millimeters thick, with no ulceration.

Stage II

Stage II is divided into stages IIA, IIB, and IIC.

Stage IIA: In stage IIA, the tumor is either:

• 1 to 2 millimeters thick, with ulceration; or
• 2 to 4 millimeters thick, with no ulceration.

Stage IIB: In stage IIB, the tumor is either:

• 2 to 4 millimeters thick, with ulceration; or
• more than 4 millimeters thick, with no ulceration.

Stage IIC: In stage IIC, the tumor is more than 4 millimeters thick, with ulceration.

Stage III

In stage III, the tumor may be any thickness, with or without ulceration, and:

• has spread to 1 or more lymph nodes; or
• has spread into the nearby lymph system but not into nearby lymph nodes; or
• has spread to lymph nodes that are matted (not moveable); or
• satellite tumors (additional tumor growths within 2 centimeters of the original tumor) are present and nearby lymph nodes are involved.

Stage IV

In stage IV, the tumor may be any thickness, with or without ulceration, may have spread to 1 or more nearby lymph nodes, and has spread to other places in the body.

Recurrent Melanoma

Recurrent melanoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the original site or in other parts of the body, such as the lungs or liver.

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