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Understanding Melanoma | Symptoms | Types | Diagnosing | Stages | Risk Factors | Resources
Melanoma is the most serious form of skin cancer, compared to basal cell and squamous cell carcinoma. But most melanomas can be cured if they’re found and treated early, before they spread. So it’s important to learn the warning signs and how the disease is diagnosed.
If you’ve already been told you have melanoma, Fred Hutchinson Cancer Center offers comprehensive treatment from a team of experts who specialize in skin cancers.
What Is Melanoma?
Melanoma is cancer that begins in melanocytes, cells that make melanin, the pigment that determines your natural skin color.
Cancer cells do not respond like healthy cells to signals that regulate cell growth, division and death. They also don’t stop growing after they have reached normal boundaries. Instead they grow into a tumor, which may invade surrounding layers of tissue and spread to other organs.
Normally, melanocytes are at the bottom of your epidermis, the outer layer of your skin. Abnormal melanocytes that have turned into cancer may grow:
- Up, forming a raised bump that you can see and feel
- Down into the second layer of your skin, the dermis
- Out along your skin
If melanoma cells enter your blood vessels or lymph vessels, they may spread to other parts of your body too.
Symptoms
Melanoma skin cancer is much more serious than basal cell carcinoma and squamous cell carcinoma. It can spread quickly to other organs and causes the vast majority of skin cancer deaths in the United States. Usually melanomas develop in or around an existing mole.
Signs and symptoms of melanoma vary depending on the exact type and may include:
- A flat or slightly raised, discolored patch with irregular borders and possible areas of tan, brown, black, red, blue or white (superficial spreading melanoma)
- A firm bump, often black but occasionally blue, gray, white, brown, tan, red or your usual skin tone (nodular melanoma)
- A flat or slightly raised mottled tan, brown or dark brown discoloration (lentigo maligna)
- A black or brown discoloration, usually under the nails, on the palms or on the soles of the feet (acral lentiginous melanoma)
In addition to watching for skin lesions or other changes described above, read about symptoms of other forms of skin cancer, and see pictures.
Learn how to examine your skin and which general skin cancer warning signs to look for.
Superficial Spreading Melanoma
This is the most common type of melanoma. It travels along the top layer of skin for a long time before going deeper. It can be found almost anywhere on the body but is more common on areas exposed to more ultraviolet (UV) light, from either the sun or an artificial source, like a tanning bed.
Appearance: The first sign is a flat or slightly raised, discolored patch with irregular borders. The color varies and might include areas of tan, brown, black, red, blue or white.
Acral Lentiginous Melanoma
This type spreads near the surface before growing deeper into the skin. It is not related to UV light and is usually found under the nails, on the palms or on the soles of the feet. Overall, this is the least common type of melanoma, but it’s the most common type in people with darker skin.
Appearance: A black or brown discoloration.
Lentigo Maligna
This type of melanoma stays close to the skin’s surface for a long time. It is more often found in older people on skin chronically exposed to and damaged by the sun.
Appearance: Usually appears as a flat or mildly elevated mottled tan, brown or dark brown discoloration.
Nodular Melanoma
This type grows into the dermis more quickly than other types do.
Appearance: Looks and feels like a firm bump, often black but occasionally blue, gray, white, brown, tan, red or your usual skin tone.
Types of Treatment for Melanoma
Fred Hutch experts offer comprehensive melanoma care at the Multidisciplinary Skin Oncology Clinic, including advanced treatments and new options available only through clinical studies.
Diagnosing
If you have not been diagnosed with skin cancer but you are concerned about your moles or other pigmented lesions, you may want to make an appointment for an evaluation at the Dermatology Clinic at UW Medical Center-Roosevelt, especially if you are at risk for melanoma.
If you have an abnormal-looking growth on your skin that might be melanoma, your physician will:
- Review and ask about your medical history and family history.
- Ask about your sun exposure, lifestyle, medicines and other risk factors.
- Ask about your symptoms, when the lesion first appeared and if it has changed in size or appearance.
- Perform a thorough physical exam and check the skin lesion, any other suspicious moles or marks and your lymph nodes.
Melanoma Biopsy
If your physician is concerned that a lesion might be cancer, they may recommend a skin biopsy. This involves taking a sample of suspicious tissue so a pathologist can examine the cells under a microscope to look for cancer cells.
Common types of skin biopsies include:
- Shave biopsy — A sterile razor blade is used to shave off the lesion.
- Punch biopsy — An instrument called a punch is used to remove a circle of tissue from the lesion.
- Excisional biopsy — A scalpel is used to remove the entire growth.
Sentinel Lymph Node Mapping and Biopsy
If you’ve been diagnosed with melanoma and your care team is concerned that cancer cells might have spread, your physician will want you to have a sentinel lymph node biopsy. In this procedure:
- A tracer substance and a dye are injected near your tumor.
- The substance flows through lymph ducts to the first lymph node or nodes where cancer cells are likely to spread (sentinel nodes).
- Your surgeon removes only the nodes where the substance appears.
- A pathologist checks the sentinel nodes for cancer.
Imaging Studies and Lab Tests
Your physician might recommend other tests or scans to learn more about your condition, especially if your tumor is deep or cancer is in your lymph nodes. These may include a computed tomography (CT) scan, chest X-ray, positron emission tomography (PET) scan, magnetic resonance imaging (MRI) scan or bone scan and tissue, blood or urine tests.
Stages
Staging is the process of finding out whether your cancer has spread and, if so, to what extent. This helps guide your treatment.
Melanoma is assigned a stage from I to IV, with I being the least advanced and IV being the most advanced.
- In stages I and II, melanoma is only in the skin.
- In stage III, nearby lymph nodes are involved.
- Stage IV melanoma affects distant organs in other parts of the body.
Risk Factors
Everyone is at some risk for melanoma and other skin cancers, but certain factors increase your risk. The major risk factor by far is exposure to UV light, especially if you have fair skin.
People with darker skin are at lower risk because they have more melanin, which provides some protection. But people with any skin tone can get melanoma.
In addition, the following factors may affect your risk for melanoma specifically:
- Family history of certain cancers — You are at increased risk if you have family members with a history of melanoma (especially if multiple relatives had it), pancreatic cancer, astrocytoma (a form of brain cancer), uveal melanoma (involving the eye) or mesothelioma.
- Moles — A mole (nevus) is a benign (noncancerous) collection of pigment cells. There’s active scientific discussion of whether moles turn into cancer. Let your physician know if a mole becomes itchy, and check your body regularly for changing moles or other possible warning signs of skin cancer.
- Dysplastic (atypical) nevi — These moles develop from childhood on through adulthood and often run in families. Lifetime melanoma risk is higher in people with dysplastic nevi.
Read details about skin cancer risk factors, including ways that UV-exposure increases your risk.
These factors relate to all three of the major skin cancers. If any apply to you, take precautions to protect yourself by limiting your sun exposure and using sunscreen.
You are at increased risk for skin cancer if:
- You have fair skin; blond, red or light brown hair; blue, green or grey eyes; or freckles. (People with darker skin are at lower risk because they have more of the pigment melanin, which provides some protection. But people with any skin tone can get skin cancer.)
- You had several blistering sunburns as a child or teen, or you burn before you tan.
- You spend a lot of time outdoors for work or recreation.
- You work indoors all week and then are exposed to sun on the weekends — while playing, gardening or washing the car without a shirt on, for example.
- You live or vacation in tropical or subtropical climates and areas with year-round, bright sunlight.
- You live, work or vacation at high altitudes.
- You have been treated for skin cancer in the past.
- One or more of your first-degree relatives (a parent, sibling or child) had skin cancer. The more family members who have had skin cancer, the higher your risk.
- You have xeroderma pigmentosum, a rare, inherited condition in which your body cannot repair DNA damage caused by ultraviolet light.
- Your immune system is weakened, such as if you are taking medications for an organ transplant, have AIDS or cancer or are on immune-suppressant medicines.
- You have used tanning beds, booths or sunlamps.
- You take any medicines that may be harmful when you are out in sunlight or make you more prone to sun damage. (These include tetracycline, sulfa drugs and some other antibiotics; naproxen sodium, ibuprofen and some other nonsteroidal anti-inflammatory drugs; phenothiazines; tricyclic antidepressants; thiazide diuretics; sulfonylureas; and medicines that lower your immunity.) If you’re not sure, ask your physician, nurse or pharmacist.
- You are older. Risk of developing skin cancer increases with age. But young people can get skin cancer too, and children are extremely susceptible to sun damage.
How Common Is It?
Overall, skin cancers are the most common cancers in the United States. But melanoma is less common than the other two major types, basal cell and squamous cell carcinoma.
Each year about 91,000 people in the U.S. are diagnosed with melanoma of the skin, according to the American Cancer Society. By comparison, about 3.3 million are diagnosed with one or more basal cell or squamous cell carcinomas.
Resources
There are many resources online for learning about your disease. We’ve compiled a list of trusted sources to help you get started.
If you or your caregiver are seeking additional information or resources, Fred Hutch Patient and Family Resource Center is available to help connect you with what you need.
Cancer Research Organizations
American Cancer Society
American Cancer Society (ACS): Overview of Melanoma
If you have melanoma or are a caregiver for someone who does, knowing what to expect can be helpful. Here you can find out all about melanoma in adults, including risk factors, symptoms and how they are found and treated.
American Society of Clinical Society
American Society of Clinical Oncology (ASCO): Guide to Melanoma
This is Cancer.Net's Guide to melanoma. Here you can learn more about melanoma, treatment, the latest research and clinical trials.
American Society of Clinical Society
ASCO Answers: Melanoma
ASCO Answers is a collection of oncologist-approved patient education materials developed by ASCO for people with cancer and their caregivers. Here you can find illustrations and information on melanoma.
CancerCare
CancerCare: Melanoma General Information and Support
CancerCare provides free, professional support services for people affected by melanoma cancer, as well as melanoma treatment information and additional resources, including financial and co-pay assistance.
CancerCare
CancerCare Treatment Update: Melanoma
The CancerCare Connect® Booklet Series offers up-to-date, easy-to-read information on the latest treatments, managing side effects and coping with cancer.
National Cancer Institute
National Cancer Institute (NCI): Melanoma-Patient Version
The NCI is the federal government's principal agency for cancer research and training. Here you can find more information about melanoma treatment, research and coping with cancer.
National Comprehensive Cancer Network
National Comprehensive Cancer Network (NCCN) Guidelines for Patients: Melanoma
This step-by-step guide to the latest advances in cancer care features questions to ask your physician, patient-friendly illustrations and glossaries of terms and acronyms.
Cancer Support Organizations
AIM at Melanoma Foundation
AIM at the Melanoma Foundation
AIM is globally engaged and locally invested in advancing the battle against melanoma through innovative research, legislative reform, education and patient and caregiver support.
AIM at Melanoma Foundation
AIM patient and caregiver support groups
Being able to talk with someone who has been through a similar experience is helpful. It provides an opportunity to discuss concerns, seek information, share ideas and learn how to cope and adapt to the outcomes and changes melanoma causes. Select "Emotional Support" once you go to the AIM website to view the list of support groups they have compiled.
CancerCare
CancerCare support group
CancerCare offers an online melanoma patient support group and provides a safe space to connect with others coping with melanoma. This group is led by an oncology social worker who provides emotional and practical support.
Impact Melanoma
Impact Melanoma
Impact Melanoma provides education, prevention and support for the most serious form of skin cancer. They are a national non-profit organization dedicated to working to reduce the occurence of melanoma.
Melanoma Research Foundation
Melanoma Research Foundation (MRF)
MRF is committed to the support of medical research in finding effective treatments and a cure for melanoma. The MRF also educates patients and physicians about prevention, diagnosis and the treatment of melanoma.
Melanoma Research Foundation
Melanoma Research Foundation (MRF): 2022 Northwest Melanoma Symposium
Video presentation from the 2022 Northwest Melanoma Symposium virtual event is available to view.
Skin Cancer Foundation
Skin Cancer Foundation
Skin Cancer Foundation has set the standard for educating the public and the medical profession about skin cancer, its prevention by means of sun protection, the need for early detection and prompt, effective treatment. It is the only international organization devoted solely to combating the world's most common cancer, now occurring at epidemic levels.