Complete Guide to Melanoma

Whether you’ve just been diagnosed or are already being treated for melanoma, you can help your doctor take better care of you by sharing any new or changing symptoms. What you say today will help shape your treatment plan.

Ask Your Doctor . . .

Newly diagnosed:

What stage is my melanoma?

What are my treatment options?

What treatment do you recommend?

What are the next steps?

Already being treated:

Is my treatment working?

If my first treatment doesn’t work, what else do you recommend?

I’m having side effects from my treatment. What can I do?

How often should I make an appointment for skin checks?

What can I do to protect my skin in the future?

TIP: Always share with your doctor any updates since your last visit—from new medicines to major life changes. These can impact your health. And be honest about how you’re feeling and whether you’re following your treatment plan. Your doctor can’t help you if he doesn’t know what’s really going on.

Melanoma is the most serious type of skin cancer. It forms in cells called melanocytes that are found in the top layer of your skin. Melanoma most commonly starts in your skin, but it can also start in other parts of your body.

When your melanocytes are healthy, they create new cells as your body needs them. These new cells push old or damaged cells to the surface of your skin, where they die and fall off.

But when you have melanoma, the DNA of your melanocytes is damaged and the cells become cancerous. DNA is inside all of your cells and makes up your genes. It tells your cells how to act and what to do. The damage to your melanocyte DNA is often caused by exposure to UV rays from the sun.

Instead of dying like they should, the cancer cells continue to make new cells that are also damaged. These cells can start to build up and eventually form a tumor.

TIP: The damage to your melanocyte DNA is often caused by exposure to ultraviolet (UV) rays from the sun. But melanomas can also happen on parts of your skin and body that aren’t usually exposed to the sun. Researchers don’t fully understand what causes these melanomas but they know they sometimes run in families.

Melanoma Stages

The stage of your melanoma tells how much your cancer has advanced. Your doctor will look at your symptoms and perform tests to diagnose the stage of your melanoma based on:

• How deeply it has grown into your skin
• Whether it has spread to your lymph nodes or other organs
• If the cancer has broken the overlying skin (ulcerated)
• After looking at your skin and talking to you, your doctor will likely perform a biopsy to learn more about the melanoma. There are several different types of biopsies, but they all work by having a small part of the suspected cancer removed and looked at closely under a microscope.

How Melanoma Spreads

If they aren’t caught early, cancerous cells can spread (metastasize) to other parts of your body. With melanoma, cancer cells spread through your blood vessels and lymph nodes. Lymph nodes are glands throughout your body that create and store cells to fight infection. Without treatment, the cancer can quickly spread through other lymph nodes or your blood to organs throughout your body.

TIP: If melanoma spreads to another part of your body, the secondary tumor is still made of skin cancer cells. For example, if melanoma spreads to your lung, you have metastatic skin cancer, not lung cancer.

Melanomas can form almost anywhere on your body. They usually form where you get the most sun, like your face, neck, back, chest, arms and legs. But hidden melanomas can form on your scalp, palms, the soles of your feet, under your nails and in your mouth, eyes, genitals or intestines. Visual signs of melanoma include:

A = Asymmetry: One side is different from the other

B =Border: The edges are blurred or irregular

C = Color: The color is uneven and may include shades of black, brown and tan (and sometimes white, red or blue)

D = Diameter: Usually 6mm or larger (about the size of a pencil eraser)

E = Evolving: It has changed in size, shape or color over time

Risk Factors for Melanoma

Anyone can get melanoma but certain things, called risk factors, mean that you are more likely to develop it. Melanoma risk factors include:

Fair complexion: pale skin, white or red hair, blue or green eyes

Moles: several large or many small moles

History of sunburn: 5 or more blistering sunburns before the age of 20 (but even one severe sunburn can increase your risk)

History of sun exposure: from the sun or from tanning beds

Family history: a parent, brother, sister or child with melanoma

Personal history: having melanoma before makes your risk of another one go up

Weak immune system: a weakened immune system because of a disease like HIV, or because of a medicine like steroid treatment for lupus

Environmental factors: exposure to radiation, solvents and industrial chemicals like vinyl chloride and polychlorinated biphenyl (PCBs) from working in a factory, for example

Age: your risk increases with age, but melanoma is one of the most common cancers in young adults

Sex: men have a higher risk than women, but only after age 50.

Having one or more risk factors for melanoma doesn’t mean that you will get the disease. It just means that you’ll want to talk to your doctor about what you can do to prevent melanoma and have regular skin checks to look for symptoms.

TIP: Just because you have dark skin doesn’t mean that you’re not at risk for melanoma. In fact, a type of melanoma called acral lentiginous melanoma (ALM), is more common in African Americans, Asians, Pacific Islanders and Hispanics. It most often happens on the palms of your hands, fingernail and toenail beds and the soles of your feet.

Your doctor will help you develop a treatment plan that will work to remove or destroy your melanoma. Your treatment plan will depend on the stage of your melanoma (how deep it is and whether it has spread), the location, your overall health, and the risks, benefits and side effects of each treatment.

Surgery

Your treatment will usually begin with surgery to remove the melanoma. You may not need any further treatment if your melanoma is at an early stage. The most common types of surgery is called wide local excision. The melanoma will be cut from your skin, including areas of healthy skin around it, to make sure all the cancer has been removed.

Other Treatment Options

If surgery cannot fully remove your melanoma, your doctor will suggest one or more of the following treatments:

Lymph node dissection—This is surgery to remove your lymph nodes in the area near your melanoma.

Chemotherapy—This uses one or more medicines to kill cancer cells, but may harm some healthy cells, as well.

Radiation—This uses high-energy radiation to kill cancer cells.

Immunotherapy—This uses medicines to help your body’s immune system find and destroy cancer cells.

Targeted Therapy—This uses medicines that can kill some cancer cells without harming healthy cells.

TIP: Some complementary or alternative treatments—like acupuncture, massage, supplements, special diets or others—might help ease your symptoms. But others can be dangerous. And none can help cure melanoma or take the place of your doctor’s treatment. So always talk to your doctor before trying something new—no matter how harmless it seems.

Because having one melanoma increases your risk for developing another, ongoing care and prevention is important. You can make small changes to your daily life to help decrease your risk or catch new melanomas early.

Examine your skin

WHY: Catching a melanoma early, before it spreads, will make it easier to treat.

HOW TO START: Make a note of all your moles, freckles and age spots, then check your skin every month for changes or new spots. (You can even use your phone to take monthly pictures of unusual moles to check for changes.) Use a mirror to look at all of your skin from your head to your toes. Don’t forget to check your scalp, the soles of your feet, between your toes, your back, buttocks and genitals. Pay special attention to your finger- and toenails if you have dark skin.

Avoid sun exposure

WHY: UV rays can damage your skin and increase your risk of developing skin cancer.

HOW TO START: The sun’s rays are strongest between 10 a.m. and 4 p.m. Avoid spending time outside during these hours. If you have to be outdoors, stay in the shade as much as possible and keep your skin covered with tight-woven clothing.

Use sunscreen carefully

WHY: If you don’t follow sunscreen directions, you may not get the protection you need.

HOW TO START: Choose a broad-spectrum sunscreen that blocks both UVA and UVB rays. Apply a generous amount to all exposed areas of skin 30 minutes before going outside. Reapply every two hours or after sweating or swimming.

Cover your head and eyes

WHY: You can’t apply sunscreen to your scalp or eyes so you need to protect them in other ways.

HOW TO START: Wear a hat with a wide brim to protect your face, neck and ears. Wear sunglasses with UV protection to shield your eyes. Look for the words “blocks 99% to 100% of all UV light” or “UV absorption up to 400nm” on the label.

Avoid tanning beds

WHY: There is no such thing as a “safe” tan. Even if you never get a burn from a tanning bed, the UV radiation is still damaging your skin.

HOW TO START: Use bronzing cosmetics or sunless tanning lotions if you want to darken your skin. But you will still need to protect your skin with sunscreen or clothing. (Do not take “tanning pills;” they are not approved by the FDA. Avoid sunless tanning booths/ spray tans that don’t provide protection for your eyes, nose and mouth.)