Melanoma is considered the most serious type of skin cancer. If caught and treated early, melanoma has a high cure rate. But if untreated, melanoma is likely to spread to other parts of the body, making it much more difficult to treat and potentially fatal. So a diagnosis of melanoma should always be taken very seriously.
Some key questions about melanoma diagnosis include:
– How is melanoma diagnosed?
– What are the different types of melanoma?
– What are the stages of melanoma and what do they mean?
– How curable is melanoma when caught early?
– What is the prognosis for more advanced melanoma?
What is Melanoma?
Melanoma is a type of skin cancer that begins in the melanocytes, the cells that produce skin pigment or melanin. Melanoma most often develops from existing moles on the skin, though it can also arise on otherwise normal looking skin. The primary cause is UV radiation from the sun or tanning beds. People with fair skin, numerous moles, and family history of melanoma are at increased risk.
Melanoma is considered the most serious type of skin cancer because it is more likely to spread to other parts of the body than other skin cancers. While basal cell carcinoma and squamous cell carcinoma (other common types of skin cancer) are typically confined to the skin, melanoma can metastasize through the bloodstream and lymph system to distant sites like the lungs, liver, brain, bones, and other organs.
Warning Signs
The key warning signs of melanoma involve changes to the appearance of a mole or spot on the skin. Signs to watch for include:
- Asymmetry – the two halves don’t match
- Irregular borders – ragged, notched, or blurred edges
- Color changes – multiple colors or color fading
- Diameter larger than 6mm – about the size of a pencil eraser
- Evolving size, shape, color, elevation, or any new symptom like itching or bleeding
How is Melanoma Diagnosed?
If a concerning mole or spot is identified, further evaluation will be needed to diagnose melanoma. The diagnostic process typically involves the following steps:
Visual Exam
The first step is a visual examination of the suspicious area by a dermatologist. The doctor will evaluate the ABCDE criteria and may use a dermatoscope, a specialized magnifying tool, to examine the lesion more closely. The dermatologist is looking for signs that melanoma is likely.
Biopsy
If melanoma is suspected, the doctor will take a biopsy to remove all or part of the concerning growth. There are several biopsy methods:
- Shave biopsy – Shaving off the top layers of skin with a small blade
- Punch biopsy – Using a tool to extract a round core of skin
- Excisional biopsy – Cutting out the entire suspicious area like a wide ellipse with a surgical knife
An excisional biopsy that removes the entire growth is preferred as it provides the most complete information about the extent of the melanoma for staging and treatment planning.
Microscopic Examination
The biopsy sample is then sent to a lab where it is examined under a microscope by a pathologist. The pathologist can determine if melanoma is present based on the characteristics and appearance of the skin cells.
Melanoma Type and Staging
If melanoma is diagnosed, further testing may be done to determine the type of melanoma and the stage or extent of spread:
Types
There are four major types of melanoma based on where they develop on the skin:
- Superficial spreading melanoma – Most common, 70% of cases. Occurs on intermittently sun exposed skin like the trunk, arms and legs.
- Lentigo maligna melanoma – Found on chronically sun exposed skin like the face and neck in older people.
- Nodular melanoma – Aggressive with distinct nodules. Accounts for 10-15% of cases.
- Acral lentiginous melanoma – Develops on palms, soles of feet, or under nails. More common in darker skinned people.
Stages
The stage of melanoma indicates the extent of spread from the original skin site:
- Stage 0 – Melanoma in situ, cancer cells only in the epidermis or outer layer of skin.
- Stage 1 – Early invasive melanoma up to 2mm deep into the dermis layer of skin. May be further divided into 1A and 1B.
- Stage 2 – The tumor is deeper into the skin but has not reached the lymph nodes. May be further divided into 2A, 2B and 2C.
- Stage 3 – The melanoma has spread to nearby lymph nodes. Further divided into 3A, 3B and 3C.
- Stage 4 – The melanoma has metastasized and spread to distant lymph nodes, skin, or other organs like the lungs, liver or brain.
The stage, along with other factors like the type and location of melanoma, help determine prognosis and treatment options.
Early Detection and Cure Rates
When detected and treated in the earliest stages, melanoma prognosis is very good. Some key early detection and cure rate statistics:
- Stage 0 or in situ melanoma is nearly 100% curable by surgical removal.
- Stage 1A melanomas have a 5-year survival rate around 97%.
- Stage 1B melanoma 5-year survival is around 92%.
- Stage 2 melanoma has 5-year survival rates from 70% to 90% depending on sub-stage.
The takeaway is that when melanoma is diagnosed and treated early, cure rates are very high. But allowing melanoma to progress to later stages drastically reduces survival statistics.
Improving Early Detection
Some ways to improve early detection of melanoma for the best prognosis include:
- Perform regular self-exams to look for new or changing moles.
- See a dermatologist annually for a full body skin cancer screening.
- Notify your doctor about any suspicious spots or moles right away.
- Know your own risk factors like family history and sun exposure.
Advanced Melanoma Prognosis and Treatment
If melanoma has reached Stage 3 or Stage 4 and spread to other parts of the body, the prognosis becomes much more serious. But there are still treatments available.
Stage 3 Melanoma
Stage 3 indicates the cancer has spread to nearby lymph nodes. The 5-year survival rates range from around 40% to 80% depending on the extent of lymph node involvement and number of tumor lesions.
Typical treatments include:
- Lymph node dissection to remove affected nodes
- Immunotherapy drugs to boost the immune system to fight cancer
- Targeted therapy drugs that attack specific cancer features
- Radiation to shrink tumors
- Chemotherapy in some cases
Stage 4 Melanoma
Stage 4 means the melanoma has metastasized to distant lymph nodes and organs. The 5-year survival rate for stage 4 is about 15% to 20%. However, treatments can still extend and improve quality of life.
Treatments for advanced stage 4 melanoma may include:
- Immunotherapy like ipilimumab or nivolumab
- Targeted drugs like vemurafenib or dabrafenib for melanomas with BRAF mutations
- Chemotherapy drugs like dacarbazine
- Radiation to shrink tumors and relieve symptoms
- Surgery to remove metastatic tumors when possible
- Clinical trials of new investigational drugs
Emerging Treatments
Research continues to improve treatment options and survival for advanced melanoma. Some emerging approaches include:
- Combination immunotherapies
- Triple combination targeted therapy
- New BRAF/MEK inhibitor drugs
- Therapeutic vaccines that stimulate the immune system
- Oncolytic virus therapy
- Localized radiation therapy techniques
These new treatments are providing hope for better outcomes in metastatic melanoma.
Coping with a Melanoma Diagnosis
Being diagnosed with any form of cancer is frightening and stressful. A melanoma diagnosis commonly triggers emotions like:
- Anxiety
- Fear
- Anger
- Sadness
- Depression
Coping strategies and support resources can help melanoma patients manage emotional distress. Some tips include:
- Learn about melanoma and treatment options
- Join a melanoma support group to connect with others facing the same battle
- Engage your medical team – ask questions and express your feelings
- Seek counseling or psychiatry services if needed
- Practice self-care through healthy habits of diet, exercise, and sleep
- Spend time doing enjoyable activities
- Lean on family and friends for comfort and support
Dealing with a melanoma diagnosis is difficult emotionally and physically. But the right resources and support network can help patients continue fighting.
Support Organizations
Reputable organizations that provide melanoma support services, education, and community include:
- Melanoma Research Foundation
- American Cancer Society
- Melanoma Research Alliance
- Skin Cancer Foundation
- Melanoma International Foundation
- AIM at Melanoma
Preventing Melanoma
While not always possible to prevent, the risk of developing melanoma can be reduced by:
- Limiting sun exposure by wearing sunscreen, protective clothing, and avoiding the midday sun.
- Avoiding tanning beds.
- Conducting regular self-exams to identify changes early.
- Seeing a dermatologist for an annual exam.
- Being aware of personal and family risk factors.
Prevention is always better than a diagnosis. But when melanoma is caught early, it is very treatable for the best possible prognosis.
Conclusion
Melanoma has the potential to be a very serious diagnosis if not caught early. But when identified in initial stages, cure rates are high. All patients should take a melanoma diagnosis seriously, educate themselves about latest treatments, and get comprehensive medical care. While an advanced melanoma prognosis may be grim, new therapies are emerging to extend life. And support services can provide emotional help and community for melanoma patients at any stage.
| Stage | 5-Year Survival Rate |
|---|---|
| Stage 0 | ~100% |
| Stage 1A | 97% |
| Stage 1B | 92% |
| Stage 2A | 81% |
| Stage 2B | 70% |
| Stage 2C | 53% |
| Stage 3A | 78% |
| Stage 3B | 59% |
| Stage 3C | 40% |
| Stage 4 | 15-20% |
