Melanoma

Melanoma, which is also called malignant melanoma, is a cancer that usually starts in the skin. It can begin in a mole, or in skin that looks perfectly normal.

The cancer grows 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 (the genetic material) in melanocytes. The cells then start to grow and divide more quickly than usual, and they can develop into melanoma.

There are 4 main types of skin melanoma.

Superficial spreading melanoma is the most common type of melanoma. You'll most often find it on the:

• arms
• legs
• chest
• back

The melanoma cells usually grow slowly at first and spread out across the surface of the skin.

Nodular melanoma is the second most common type of melanoma. It can grow more quickly than other melanomas, and it's more likely to lose its colour as it grows, so it turns red rather than black.

You're more likely to find nodular melanoma on the:

• chest
• back
• head
• neck

Lentigo maligna melanoma is less common than some other types of melanoma. You usually find it in older people, on areas of skin that have had a lot of sun, like the face and neck. It develops from a slow-growing, pre-cancerous condition called lentigo maligna.

Lentigo maligna stays in the upper layer of the skin, called the epidermis. Some people call it an insitu melanoma.

It usually looks flat, like a stain or a large freckle on the skin, and it's sometimes called a Hutchinson's freckle.

If it spreads into the deeper layers of the skin, it's no longer pre-cancerous. At that point it's called lentigo maligna melanoma. Even then, it's still usually slow-growing.

Acral lentiginous melanoma is rare. It's usually found on the:

• palms of the hands
• soles of the feet
• under fingernails or toenails

It's more common in people with black or brown skin, and it's not thought to be caused by sun exposure.

If you have darker skin because of your ethnicity, check your skin for any dark spots or changes in these areas.

Melanoma can also appear in a few other rare forms. These include:

• desmoplastic melanoma
• amelanotic melanoma
• spitzoid melanoma
• malignant blue naevus

If you notice a change in a mole, or a new mole appears, you'll usually start by seeing your doctor.

Your doctor will check the mole and ask whether anyone in your family has had cancer. If they think you may have melanoma, they'll refer you to a dermatologist, which is a doctor who specialises in skin conditions.

You should be seen at the hospital within 2 weeks.

If tests show the mole is 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:

A sentinel lymph node biopsy checks the lymph nodes closest to the melanoma. You may have this test even if your lymph nodes don't look or feel swollen, because it can help find very tiny amounts of melanoma that have spread to the lymph nodes.

An ultrasound scan uses sound waves to build up a picture of an area of the body. For melanoma, the area scanned is where the lymph nodes are.

The person doing the scan spreads gel over that area. They then pass a small probe over it, and the probe makes the sound waves. A computer changes the sound waves into a picture.

If the ultrasound scan of your lymph nodes shows something abnormal, the doctor will do a fine needle aspiration. For this, the doctor puts a very fine needle into the lymph node and draws a sample of cells out into the syringe.

The sample goes to the laboratory, where it is looked at under a microscope for melanoma cells.

If melanoma has spread to the lymph nodes, you may need some more tests to check whether it has spread anywhere else in the body. These are:

A CT scan takes a series of X-rays and puts them together to build a three-dimensional picture of the inside of your body.

A PET-CT scan combines two types of scan, a CT scan and a PET scan. The PET part uses a low dose of radiation to measure how active the cells are in different parts of your body.

An MRI scan uses magnetism to build up a detailed picture of areas of your body, which can help doctors check for melanoma.

Your doctor may arrange tests on the melanoma cells to look for certain gene changes (mutations). The results tell your cancer doctor which targeted or immunotherapy drugs are likely to work for you, in case you need them.

Your test results tell the doctors more about the size and position of the melanoma, and whether it has spread. This is called staging.

Once the doctors know the stage, they can decide on the best treatment for you.

If tests show that the melanoma has spread to nearby lymph nodes, your doctor will talk with you about the best way to treat it.

You and your doctor may decide that regular ultrasounds of your lymph nodes are the best option for you. These scans check whether the cancer is growing in that area and whether you need treatment.

Or your doctor may talk to you about further treatment with targeted or immunotherapy drugs. This is called adjuvant treatment, and it is meant to lower the risk of the melanoma coming back.

Sometimes your doctor may bring up surgery to remove all the nearby lymph nodes. This may depend on the risk of the melanoma causing symptoms in that area.

After your melanoma treatment, your doctor or specialist nurse will explain which follow-up appointments you need. How many you have 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 the melanoma coming back and needing treatment.

At these appointments, your doctor or nurse will look over your skin carefully, 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)

You should check yourself for any signs of melanoma at least once a month. If another melanoma develops, there's a better chance of a cure when it's found early.

If you have symptoms, contact your specialist doctor or nurse. You can do this between your follow-up appointments too.

Your specialist doctor or nurse will ask you to check:

• your scar and the surrounding area
• the skin all over your body for any new or changing moles

Standing in front of a mirror can help when you check your skin. If you're not sure how to do it, ask your doctor or nurse. The ABCDE check list shows you what to look for.

They may also ask you to check your lymph nodes after your treatment. The shower or bath is a good time to do this. The British Association of Dermatologists produces a leaflet with advice about how to check your lymph nodes.

Protecting your skin from the sun can also lower your risk of another melanoma. Your doctor or nurse will give you advice about this.

Macmillan Cancer Support have more information about skincare in the sun after melanoma.

Doctors try to keep the effect of skin cancer treatment on your appearance as small as they can. Many people are left with only minor scarring, but for others the scars 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 advise you on the best way to cover the scars up.

Cancer and its treatment can cause physical and emotional changes, and these may affect your sex life.

Some cancer drugs can affect your fertility. If you're thinking of getting pregnant, or of making someone pregnant, after melanoma treatment, talk to your specialist nurse or doctor first. They can give you more information that may support you in planning a pregnancy. What they tell you will depend on the melanoma treatment you had and on any follow up tests you need.

Even if you already live a healthy life, you may choose to make some positive changes after your melanoma treatment. Small changes, such as eating well and keeping active, can improve your health and wellbeing. They also support your body as it recovers from cancer treatment.