Melanoma

Melanoma is the most serious type of skin cancer. When found early, however, it is highly treatable.

WHO IS AT RISK FOR MELANOMA?

While anyone can develop melanoma, some people have a higher risk than others, including those with:

  • Light skin, hair and eyes:
  • Fair skin that tans poorly or burns easily.
  • Red or blond hair.
  • Blue or green eyes.
  • Certain moles:
  • 50 or more small moles.
  • Unusual-looking moles that are often larger than normal and have uneven edges (may be called dysplastic nevi or atypical moles).
  • Past blistering sunburns or a history of indoor tanning.
  • A previous melanoma or another skin cancer.
  • A close blood relative (i.e., parent, child, sibling, aunt or uncle) who has had melanoma.
  • A weak immune system (due to disease, organ transplant or medications).

Caucasians and men older than 50 have a higher risk of developing melanoma than the general population.

WHAT ARE THE WARNING SIGNS OF MELANOMA?

Identify the warning signs of the disease by looking for the ABCDEs of melanoma.


A stands for ASYMMETRY. One half does not look like the other half.


B stands for BORDER. The spot has an irregular, scalloped or poorly defined border.


C stands for COLOR. The spot is varied from one area to another, with shades of tan and brown or black, or sometimes white, red or blue.


D stands for DIAMETER. While melanomas are usually greater than 6 mm (the size of a pencil eraser) when diagnosed, they can be smaller.


E stands for EVOLVING. A mole or skin growth looks different from the rest or is changing in size, shape or color.

Nail melanoma starts off as a brown or black vertical band on the nail. It may be associated with splitting, redness, pain or bleeding of the nail.

People With Skin of Color

While not common in people with skin of color, skin cancer is often diagnosed at a more advanced stage in this group, which can make it more difficult to treat. In people with skin of color, skin cancer is often found in areas of the body that are not typically exposed to the sun. When examining their skin, people with skin of color should pay special attention to the palms of the hands, the soles of the feet, their fingernails and toenails, the inside of the mouth, and the groin and buttocks.

If you find any new or suspicious spots on your skin, or any spots that are changing, itching or bleeding, make an appointment to see a board-certified dermatologist.

HOW SHOULD I CHECK MY SKIN FOR SIGNS OF SKIN CANCER?

Performing a skin self-exam means taking note of all the spots on your body, from moles to freckles to age spots. Skin cancer can develop anywhere on the skin and is one of the few cancers you can usually see on your body. Ask someone for help when checking your skin, especially in hard-to-see places like the back. Follow these steps:

HOW DOES A DERMATOLOGIST DIAGNOSE MELANOMA?

If you or your dermatologist find a suspicious mole or growth, your dermatologist will perform a skin biopsy. A biopsy is the only way to tell whether you have melanoma or another type of skin cancer.

A skin biopsy is a simple procedure that a board-certified dermatologist can do in the office using local anesthesia. To perform a biopsy, your dermatologist will numb your skin and remove all or a part of the growth. This growth will be examined under a microscope.

If the diagnosis is melanoma, the dermatologist may be able to tell you what stage of cancer you have.

Sometimes a surgical procedure known as a sentinel lymph node biopsy is necessary to identify the stage of melanoma. When melanoma spreads, it often travels first to the closest (“sentinel”) lymph nodes. By removing one or a few of these lymph nodes, the doctor can tell whether the melanoma has spread to nearby lymph nodes.

Your dermatologist may refer you to another doctor for more tests. These tests can include X-rays, ultrasounds, computerized tomography, magnetic resonance imaging and positron emission tomography.

If you have an early, thin melanoma, your dermatologist may not recommend a sentinel lymph node biopsy or other diagnostic tests.

HOW DOES A DERMATOLOGIST TREAT MELANOMA?

Your treatment will depend on how deeply the melanoma has grown into your skin, whether the melanoma has spread to other parts of the body and your overall health.

Treatment often starts with surgery. In its earliest stage, melanoma grows in the epidermis (outer layer of skin). Your dermatologist may refer to this as melanoma in situ. Your dermatologist will want to remove all of the cancer. Surgical treatment options include:

  • Excision. This procedure is appropriate for most melanomas. Your dermatologist will numb your skin and surgically remove the melanoma. Some of the normal-looking skin around the melanoma also will be removed. The removed tissue will be sent to a lab to make sure that there are no remaining melanoma cells.
  • Mohs surgery. For some types of melanoma in certain areas of the body, a specialized procedure called Mohs surgery is a treatment option that your dermatologist may recommend. A dermatologist who has completed additional training can perform Mohs surgery.

When melanoma is caught early, surgery may be the only treatment you need. Other treatment options, such as topical therapy and radiation, may be used if surgery is not appropriate. Your dermatologist will evaluate all possible options and help determine the best treatment for you.

When melanoma grows deeper into the skin or spreads, treatment becomes more complex.

In that case, your dermatologist along with a medical team will determine if systemic treatment with chemotherapy, immunotherapy or targeted therapy may be appropriate. 

WHAT ARE MY CHANCES OF DEVELOPING ANOTHER MELANOMA?

Melanoma survivors have an approximately nine-fold increased risk of developing another melanoma compared to the general population. Due to this risk, it is essential that you keep all appointments with your dermatologist and perform skin self-exams regularly (or as often as your dermatologist has instructed you to) to check for new or suspicious spots, or anything changing, itching or bleeding.

HOW CAN I REDUCE MY RISK OF MELANOMA?

Exposure to ultraviolet light from the sun and indoor tanning beds is the most preventable risk factor for all skin cancers, including melanoma. You can decrease your risk by protecting your skin from the sun’s harmful UV rays when you’re outdoors. Follow these tips:

  • Seek shade. The sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow appears to be shorter than you are, seek shade.
  • Wear protective clothing, such as a lightweight long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, when possible.
  • Generously apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to all exposed skin. Broad-spectrum sunscreen provides protection from both UVA and UVB rays. Research suggests that regular sunscreen use reduces melanoma risk.
  • Use sunscreen whenever you are going to be outside, even on cloudy days.
  • Apply enough sunscreen to cover all exposed skin. Most adults need about 1 ounce — or enough to fill a shot glass — to fully cover their body.
  • Don’t forget to apply to the tops of your feet, your neck, your ears and the top of your head.
  • When outdoors, reapply sunscreen every two hours, even on cloudy days, and after swimming or sweating.
  • Use extra caution near water, snow and sand because they reflect and intensify the damaging rays of the sun, which can increase your chances of sunburn.
  • Avoid tanning beds. If you want to look tan, consider using a self-tanning product, but continue to use sunscreen with it.

A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about melanoma or to find a board-certified dermatologist in your area, visit aad.org/melanoma or call toll-free (888) 462-DERM (3376).

Visit the SPOT Skin Cancer® website — SpotSkinCancer.org — to learn how to perform a skin self-exam, download a body mole map for tracking changes on your skin and find free skin cancer screenings in your area. Those affected by skin cancer can also share their story via the website and download free materials to educate others in their community.

All content solely developed by the American Academy of Dermatology.

Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

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