What is melanoma?
Melanoma is a type of skin cancer that develops from melanocytes, the pigment-producing cells in the skin. It is considered the most serious and deadly form of skin cancer, as it tends to spread quickly to other parts of the body if not caught and treated early. Melanoma most often appears as a new or changing mole on the skin that looks abnormal compared to other moles. It may have an irregular shape, uneven color, large size, or be rapidly changing in appearance. While melanoma accounts for only about 1% of all skin cancers, it is responsible for the majority of skin cancer deaths.
What causes melanoma?
There are several factors that can increase the risk of developing melanoma:
- Ultraviolet (UV) light exposure from the sun or tanning beds – This is the #1 risk factor, with sunburns early in life particularly harmful.
- Fair skin that burns easily and tans poorly.
- Large number of moles or atypical moles.
- Family history of melanoma.
- Weakened immune system, such as in organ transplant recipients.
- Older age, most cases occur after age 50.
However, melanoma can still occur even without any known risk factors. Anyone can potentially develop melanoma regardless of age, sex, or race. Doing regular self-skin exams to look for any new or changing moles is important for early detection.
What are the types of melanoma?
There are four main types of melanoma:
Superficial Spreading Melanoma
This is the most common type, accounting for about 70% of cases. It typically appears as a flat or slightly raised discolored patch on sun-exposed areas like the back, legs, arms and face. It may develop from an existing mole.
Nodular Melanoma
This is a fast-growing vertical growth pattern forming a bump. It accounts for about 15% of melanomas. While it is usually black, it can also appear pink, red, white, blue, gray.
Lentigo Maligna Melanoma
This occurs on chronically sun-exposed areas, especially the face of older adults. It grows slowly over many years from lentigo maligna (stage 0 melanoma).
Acral Lentiginous Melanoma
This rare type appears on the palms of the hands, soles of the feet, or under nails. It is more common on darker skin types andEast Asians. The nails may show dark streaks.
What are the ABCDEs of melanoma?
| ABCDE Feature | Meaning |
| Asymmetry | One half is unlike the other half. |
| Border | The edges are irregular, ragged, notched or blurred. |
| Color | Shades of black, brown and tan. May have white, red, blue or bluish-black spots. |
| Diameter | Larger than 6 mm or about the size of a pencil eraser. Any growth or mole should be checked. |
| Evolving | Change in size, shape, color, elevation, any new symptom like bleeding, itching or crusting. |
These ABCDE features help distinguish melanomas from benign moles. See a dermatologist promptly if you have any new or changing spots on your skin showing these signs. Catching melanoma early offers the best chance for a cure.
What are the stages of melanoma and 5 year survival rates?
Melanoma stages indicate how far the cancer has spread. Higher stages have a worse prognosis.
Stage 0 – 100% 5-year survival
Melanoma in situ, earliest stage where abnormal melanocytes are only in the outermost layer of the skin.
Stage 1A – 97% 5-year survival
Tumor thickness under 1mm, no ulceration, mitosis < 1/mm2.
Stage 1B – 92% 5-year survival
Tumor thickness under 1mm with ulceration or mitosis ≥ 1/mm2.
Stage 2A – 81% 5-year survival
Tumor thickness 1 to 2 mm without ulceration.
Stage 2B – 70% 5-year survival
Tumor thickness 1 to 2 mm with ulceration OR thickness 2 to 4mm without ulceration.
Stage 2C – 53% 5-year survival
Tumor thickness 2 to 4mm with ulceration OR ≥ 4mm thick.
Stage 3 – 63% 5-year survival
Cancer has spread to nearby lymph nodes.
Stage 4 – 15-20% 5-year survival
Cancer has spread to distant organs like the lung, liver or brain. This is metastatic melanoma with poorest prognosis.
The outlook is better when melanoma is diagnosed and treated early before advancing to later stages.
How is melanoma diagnosed?
To diagnose melanoma, the suspicious mole or skin growth will be examined first visually, then possibly with the following tests:
- Skin biopsy – The only definitive way to confirm melanoma is by removing all or part of the suspicious growth for examination under a microscope. A biopsy can determine if cancer is present, the type of melanoma, and how deeply it has invaded the skin.
- Sentinel lymph node biopsy – This helps determine if melanoma has spread to the lymph nodes which signals a higher cancer stage. A dye is injected at the tumor site, which travels to the sentinel node(s) draining that area. The sentinel nodes are removed and examined for cancer.
- Imaging tests like CT, MRI, PET scans – Once melanoma is diagnosed, imaging scans are done to look for any spread of cancer to other organs. This helps determine the stage.
Catching melanoma early while it is still small and thin offers the best prognosis. Thick, invasive melanomas are harder to control.
Can you get rid of melanoma?
The first goal of treatment is to get rid of the melanoma tumor and any cancer spread while preserving normal tissue function and appearance as much as possible. The main treatment options include:
Surgery to remove melanoma
The primary tumor, some surrounding normal tissue, and possibly lymph nodes will be surgically removed to get rid of the cancer. Depending on factors like location, size, and stage, this may involve:
- Excisional surgery to cut out the tumor and some surrounding normal skin
- Mohs surgery to remove thin layers of skin until no cancer cells remain
- Lymph node dissection if nodes are enlarged or test positive for cancer
Advanced melanoma may require removal of multiple growths or extensive areas of skin. A skin graft or flap procedure may be done to cover the wound.
Immunotherapy drugs
Immunotherapy helps boost the body’s immune system to attack melanoma. Drugs like ipilimumab, nivolumab, and pembrolizumab are frequently used. They have improved survival for advanced cancers. Milder side effects include fatigue, rash, and diarrhea.
Targeted therapy drugs
Some oral medications target specific gene mutations in melanoma cells. Examples are dabrafenib, trametinib, vemurafenib. They are effective for cancers with BRAF gene mutations. Side effects may include skin problems, fever, joint pain.
Chemotherapy
Drugs like dacarbazine DTIC destroy rapidly dividing cancer cells but also affect normal cells. Chemotherapy may be used for spread melanoma when other treatments don’t work. Side effects often include hair loss, nausea, fatigue.
Radiation therapy
Radiation directs high energy beams to kill cancer cells and shrink tumors. It may be used after surgery to help prevent recurrence in the affected area. Side effects include skin irritation and hair loss.
Ablative therapies
For small tumors, options like cryosurgery to freeze cancer cells or laser ablation to target tumor cells with light beams may be used.
Combining treatments like surgery, immunotherapy, radiation often gives the best chance of getting rid of melanoma, especially for advanced disease. Newer treatments continue to improve outlooks. When detected early, melanoma is often curable.
Can melanoma come back after being removed?
Yes, there is always a risk that melanoma can return after initial treatment and apparent removal. This is called recurrence. The more advanced the original cancer, the higher the risk of recurrence. Stage 4 melanoma with distant spread has the highest recurrence rates.
Recurrence usually occurs within the first five years after initial diagnosis and treatment. But melanoma can also return many years later. Recurrent melanoma is harder to treat and control.
Following initial treatment, regular skin exams, imaging tests, and blood tests should continue to look for any signs of recurrence. CT/PET scans done at follow up visits can detect if melanoma has come back in other parts of the body. Let your doctor know of any new symptoms like lumps, swelling, weight loss. Swift evaluation and treatment gives the best chance of defeating recurrent melanoma.
Factors that increase recurrence risk include:
- Thicker primary tumor > 1 mm depth
- Advanced original stage – Stage 3 or 4
- High mitotic rate in tumor cells
- Melanoma not completely removed with clear surgical margins
- Lymph nodes were initially positive for cancer spread
- Ulceration was present in primary tumor
- Recurrence within 2 years after initial treatment
Even for early stage melanoma, follow up is essential as recurrence can happen. Let your doctor know promptly about any symptoms or changes that could signal melanoma has returned.
What are the warning signs of recurrent melanoma?
Be on the lookout for these red flags that may indicate melanoma has come back:
- New black or dark brown skin growths
- Changes in existing moles – increase in size, irregular edges, color changes, itching or bleeding
- Appearance of lumps or nodules under the skin near original melanoma site or in other locations like the lymph nodes, abdomen, chest
- Unexplained loss of weight and appetite
- Pain, swelling or sense of fullness near melanoma site or lymph nodes
- Headaches, seizures, dizziness or other neurological symptoms
- Shortness of breath, chronic cough, chest pain
- Abdominal bloating, jaundice
- Fatigue, weakness
- Persistent fevers and chills
Contact your doctor promptly if you experience any unusual or persistent signs and symptoms after melanoma treatment. Don’t wait. Diagnosing recurrent melanoma quickly offers the best chance for additional treatment before cancer can spread further.
Can you prevent melanoma from coming back?
While no prevention methods are 100% guaranteed, these strategies can help lower your risk of melanoma returning after initial treatment:
- Sun protection – Generous use of broad spectrum, water resistant sunscreen with SPF 30 or higher reduces UV damage that can lead to new skin cancers.
- Avoid tanning – Don’t use tanning beds or sunbathe. UV radiation promotes melanoma recurrence.
- Regular skin self-exams – Frequently check all skin areas for new or changing moles and lesions. Familiarize yourself with your moles to notice any abnormalities.
- Skin cancer surveillance – Get a full body skin exam by your doctor every 6-12 months to spot any concerning lesions early.
- Immunotherapy – Some Stage 3 melanoma patients may receive immunotherapy drugs after surgery to help prevent recurrence.
- Healthy lifestyle – Eat nutritious foods, exercise regularly, avoid smoking and heavy drinking.
- Manage stress – Chronic stress may negatively affect the immune system, worsening cancer outcomes.
- Regular medical care – Keep all follow up appointments for monitoring tests. Report any suspicious symptoms promptly.
Detecting recurrent melanoma early offers the best prognosis for additional treatment. While melanoma can return despite preventive measures, reducing UV exposure and practicing early detection methods can improve your odds.
What is the prognosis if melanoma recurs?
The prognosis for recurrent melanoma largely depends on:
- How much time passed since initial diagnosis and treatment – Longer time periods generally indicate better outcomes.
- The stage of the original melanoma – More advanced stages have higher recurrence rates and are harder to treat again.
- Where the recurrence is located – Regional or distant recurrence have worse prognoses than local recurrence.
- How much cancer has spread at the time of recurrence – Widespread metastases are more difficult to control.
- The patient’s overall health.
- Treatments available – Newer immunotherapy drugs are improving outlooks for advanced recurrences.
If detected early while still localized, recurrent melanoma may be treated successfully with surgery alone in some cases. But survival rates drop sharply if melanoma has extensively metastasized by the time of recurrence.
Overall 5-year survival rates for recurrent melanoma:
- Local recurrence only – 50-80% survival
- Regional recurrence – 20-70% survival
- Distant recurrence – 10-15% survival
Catching and treating any recurrence early provides the best chances of survival. Patients with recurrent melanoma need close monitoring and follow up care. Let your doctor know right away about any new or concerning symptoms you experience between follow up visits. Don’t delay getting evaluated.
Conclusion
Melanoma is a serious skin cancer that has the potential to spread and be life-threatening if not caught early. However, when detected in early stages, melanoma is often curable with treatment. Getting rid of an existing melanoma tumor involves surgery, and may be followed by immunotherapy, radiation, or other therapies to help prevent recurrence.
Despite successful initial treatment, melanoma can sometimes return. The more advanced the original cancer, the higher the risk of recurrence. That’s why it’s critical to do regular skin self-exams, get yearly skin checks by your dermatologist, and promptly report any new or suspicious moles or symptoms to your doctor. Speedy diagnosis and treatment of recurrent melanoma provides the best outlook. While melanoma is a dangerous cancer, the prognosis continues to improve thanks to advanced treatments and awareness of prevention and early detection methods.
