Melanoma
Melanoma
On this page:
- What is melanoma?
- Symptoms of melanoma
- What causes melanoma?
- Tests and diagnosis for melanoma
- Stages of melanoma
- Treatment for melanoma
- After melanoma treatment
What is melanoma?
Melanoma, also known as malignant melanoma, is a cancer that usually begins in the skin. It can start in an existing mole or in skin that looks perfectly normal.
Melanoma develops from skin cells called melanocytes. These cells make melanin, the pigment that gives your skin its colour.
UV radiation from sunlight, sunbeds or sunlamps can build up over time and damage the DNA (genetic material) inside melanocytes. The damaged cells then start to grow and divide faster than they should, and this can develop into melanoma.
There are 4 main types of skin melanoma.
Superficial spreading melanoma
Superficial spreading melanoma is the most common type of melanoma. It is most often found on the:
- arms
- legs
- chest
- back
The melanoma cells usually grow slowly at first, spreading outwards across the surface of the skin.
Nodular melanoma
Nodular melanoma is the second most common type. It can grow more quickly than other melanomas. It is also more likely to lose its colour as it grows, turning red rather than black.
It is more commonly found on the:
- chest
- back
- head
- neck
Lentigo maligna melanoma
Lentigo maligna melanoma is less common. It is usually seen in older people, on areas of skin that have had a lot of sun over the years, such as the face and neck. It develops from a slow-growing, pre-cancerous condition called a lentigo maligna.
A lentigo maligna sits only in the upper layer of skin, called the epidermis. It is sometimes called an in situ melanoma.
It usually looks flat, like a stain or a large freckle on the skin. You may also hear it called a Hutchinson's freckle.
If it spreads into the deeper layers of skin, it is no longer pre-cancerous and is then called lentigo maligna melanoma. Even at this stage, it is still usually slow-growing.
Acral lentiginous melanoma
Acral lentiginous melanoma is rare. It is usually found on the:
- palms of the hands
- soles of the feet
- skin under the fingernails or toenails
It is more common in people with black or brown skin, and it is not thought to be caused by sun exposure.
If you have darker skin because of your ethnicity, it is important to check these areas regularly for any dark spots or changes.
Other rare types of melanoma
Other rare types of melanoma include:
- desmoplastic melanoma
- amelanotic melanoma
- spitzoid melanoma
- malignant blue naevus
Further information
Macmillan Cancer Support has more information about melanoma that:
- comes back in the same area, known as recurrent melanoma
- has spread to other parts of the body, known as advanced melanoma
Rarely, melanoma can start in parts of the body other than the skin.
Macmillan Cancer Support has separate information about melanoma that starts in:
- the eye, called ocular melanoma
- the anus and rectum (back passage), called anorectal melanoma
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
What causes melanoma?
The biggest risk factor for melanoma is exposure to ultraviolet (UV) light. This can come from sunlight or from sunbeds.
In the UK, about 16,700 people are diagnosed with melanoma each year, and the number of people diagnosed is rising.
Like most cancers, melanoma is more common in older people. But it is more common in younger people, in their teens and 20s, than some other cancers are.
Macmillan Cancer Support has more information about the causes and risk factors of melanoma.
Diagnosis
If you notice a mole changing, or a new mole appears, the first step is usually to see your GP or a general doctor.
Your doctor will look at the mole and ask whether anyone in your family has had cancer. If they think it could be a melanoma, they will refer you to a dermatologist, a doctor who specialises in skin conditions.
You should be seen at the hospital within 2 weeks.
At the hospital
The dermatologist will look at your mole with a dermatoscope. This is a hand-held device that looks like a small magnifying glass.
They will check the rest of your skin too. They will ask about any other changes to your skin, and whether you have any other moles that look unusual.
They may also feel the lymph nodes (glands) closest to the mole to see whether they look or feel swollen.
If you have an unusual mole, your dermatologist may suggest keeping an eye on it regularly rather than removing it. These moles are sometimes called dysplastic naevi.
Your dermatologist may ask you to come back in a few months to see whether the mole has changed. Or they may arrange for you to come back regularly to have photographs taken of the mole so any change can be tracked.
If you have symptoms of melanoma, the mole will need to be removed so the specialist can find out exactly what it is. This is called an excision biopsy.
Waiting for test results can be a hard time. Macmillan Cancer Support has more information that may help.
Tests to check your lymph nodes
If tests show the mole is a melanoma, your doctor may suggest tests to check the lymph nodes nearby.
Not everyone needs these tests. It depends on how deep the melanoma is and whether the lymph nodes look or feel swollen. Lymph node tests include the following.
Sentinel lymph node biopsy (SLNB)
A sentinel lymph node biopsy checks the lymph nodes closest to the melanoma.
You may have this test even if your lymph nodes do not look or feel swollen. It can pick up very tiny amounts of melanoma that have spread to the lymph nodes.
Ultrasound
An ultrasound scan uses sound waves to build up a picture of an area inside the body.
The person doing the scan spreads gel over the area where the lymph nodes are. They then pass a small probe, which gives off sound waves, over this area.
A computer turns the sound waves into a picture.
Fine needle aspiration (FNA)
If the ultrasound of the lymph nodes looks abnormal, the doctor will do a fine needle aspiration. A very fine needle is placed into the lymph node and a sample of cells is drawn up into the syringe.
The sample is sent to the laboratory and examined under a microscope for melanoma cells.
Further tests
If the melanoma has spread to the lymph nodes, you may have the following tests to check whether it has spread anywhere else in the body.
CT scan
A CT scan takes a series of X-rays and puts them together into a three-dimensional picture of the inside of the body.
PET-CT scan
A PET-CT scan combines a CT scan with a PET scan. A PET scan uses low-dose radiation to measure how active the cells are in different parts of the body.
MRI scan
An MRI scan uses magnetism to build up a detailed picture of areas of your body.
Tests on the melanoma cells
Your doctor may arrange tests to look for certain gene changes (mutations) in the melanoma cells. The results tell your cancer doctor which targeted or immunotherapy drugs are likely to work for you, should you ever need them.
Stages of melanoma
The results of your tests help your doctors learn more about the size and position of the melanoma and whether it has spread. This is called staging.
Knowing the stage of the melanoma helps doctors decide on the best treatment for you.
Treatment
Treatment for melanoma
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Most people will have surgery to remove more tissue from the area where the mole was removed. This is called a wide local excision. The aim is to remove all the cancer cells.
For early melanoma, this is often the only treatment you’ll need. Early melanoma means the cancer cells are only in the skin and haven’t spread from where the mole started.
Macmillan Cancer Support have advice on getting organised before cancer treatment.
If melanoma has spread to nearby lymph nodes
If tests show the melanoma has spread to nearby lymph nodes, your doctor will talk to you about the best way of treating this.
You and your doctor may decide that having regular ultrasounds of your lymph nodes is the best option for you. These ultrasounds check if the cancer is growing in that area and if you need treatment.
Or your doctor may talk to you about having further treatment with targeted or immunotherapy drugs. This is called adjuvant treatment. It aims to reduce the risk of the melanoma coming back.
Sometimes your doctor may talk to you about having surgery to remove all the nearby lymph nodes. This may depend on the risk of the melanoma causing symptoms in that area.
Adjuvant (further) treatment
Your doctor may offer you further treatment to reduce the risk of melanoma coming back after surgery. This is called adjuvant treatment. It’s an option if there are factors that increases the risk the of melanoma coming back.
It may be used for stage 2 melanoma. You may have a type of immunotherapy drug called pembrolizumab.
It may also be used for stage 3 melanoma. If tests show a BRAF gene mutation in the melanoma cells, you may have a combination of 2 targeted therapy drugs. These drugs are called dabrafenib and trametinib. If tests don’t find a BRAF gene mutation, you may have one or, sometimes, a combination of immunotherapy drugs. These drugs are called Ipilimumab, pembrolizumab and nivolumab.
You’ll usually have adjuvant treatment for up to 12 months. Your doctor and nurse will talk to you about the possible benefits and risks of having it. It’s important to think about all these and how treatment and possible side effects may affect your daily life.
Sometimes your doctor may suggest not having treatment straightaway. They may do this if the risks of treatment outweigh the benefits. Instead your doctor may advise having regular appointments and tests.
Your specialist doctor or nurse will talk to you about the different treatment options. They’ll also discuss things to think about when making treatment decisions.
You can then decide together what treatment is best for you. You may be offered some treatments as part of a clinical trial.
Macmillan Cancer Support have more information about treatment for melanoma.
Treatment for melanoma that has spread
Sometimes melanoma can’t be removed with surgery, or tests show that the cancer cells have spread to other areas of the body. Your doctor and nurse will talk to you about the best way of managing this.
If you need treatment, this usually involves having targeted therapy or immunotherapy drugs.
Macmillan Cancer Support have more in our information about advanced melanoma.
After melanoma treatment
After your treatment, your doctor or specialist nurse will explain the follow-up appointments you need. This depends on the stage of the melanoma.
If you had surgery to remove a melanoma in situ (stage 0), you may have one follow-up appointment. You won’t need ongoing appointments.
For other stages of melanoma, you may have regular appointments over several years. Some people will be offered regular scans if there’s a higher risk of melanoma coming back and needing treatment.
At the appointments, your doctor or nurse will examine your skin carefully. This is because after a melanoma, you have a higher risk of getting another one. They may take photographs of your skin and measure some of your moles. This is a way of checking for any changes in your skin.
They’ll also check:
- areas where melanoma was removed for signs of it coming back in the same place
- your scar and the surrounding area
- your lymph nodes closest to where the melanoma was – if you had surgery to remove these, they may also check lymph nodes elsewhere in your body
Getting support
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.
Macmillan Cancer Support also has further information to support you. You can:
- phone the Macmillan Support Line on 0808 808 00 00
- chat to Macmillan specialists online
- use the Macmillan melanoma cancer forum – you can talk to others affected by melanoma, ask questions and share your experience
Other organisations who offer information and support include:
- Melanoma Focus information, guidance and support for patients, carers and healthcare professionals
- Melanoma UK – support and information for patients, carers and healthcare professionals
Checking your skin and sun skincare
It’s important to check yourself for any signs of melanoma at least once a month. If another melanoma develops, there’s a better chance of a cure if it’s found early.
If you have symptoms, contact your specialist doctor or nurse. Remember, you can contact them between your follow-up appointments.
Your specialist doctor or nurse will ask you to check:
- your scar and the surrounding area
- the skin on all over your body for any new or changing moles
It can be helpful to stand in front of a mirror to check your skin. Ask your doctor or nurse if you’re not sure how to check. The ABCDE check list helps you to know what to look for.
They may also ask you to check your lymph nodes after your treatment. A good time to do this is in the shower or bath. The British Association of Dermatologists produces a leaflet with advice about how to check your lymph nodes.
You can also reduce your risk of another melanoma by protecting your skin from the sun. Your doctor or nurse will give you advice about this.
Macmillan Cancer Support have more information about skincare in the sun after melanoma.
Body image after melanoma
Doctors try to minimise the effects of skin cancer treatments on your appearance. Many people have only minor scarring after treatment, but for others it may be more obvious.
If scars after surgery bother you or make you feel self-conscious, some skin clinics have a make-up specialist. They can give you advice on the best way to cover up scars.
Sex, fertility and pregnancy after treatment
Cancer and its treatment can cause physical and emotional changes that may affect your sex life.
Macmillan Cancer Support have information on cancer and sex.
Some cancer drugs can affect your fertility. If you’re thinking of getting pregnant or making someone pregnant, after melanoma treatment, talk to your specialist nurse or doctor first. They can give you more information that may help you plan a pregnancy. This will depend on the melanoma treatment you had and any follow up tests you need.
Macmillan Cancer Support have more information about pregnancy and cancer.
Complications
Wellbeing and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.
Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.
Macmillan Cancer Support have advice on finishing cancer treatment.
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