Melanoma

Introduction

Definition of melanoma

A form of cancer that begins in melanocytes. Melanocytes are cells that make the pigment melanin. It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.

 


Anatomy of the skin, showing the epidermis, dermis, and subcutaneous tissue. [no-glossary]Melanocytes[/no-glossary] are in the layer of basal cells at the deepest part of the epidermis.

 

PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES
As treatments are becoming more personalized due to the advances in cancer care, we would kindly ask you to contact info@anticancerfund [dot] org for a more appropriate guidance according to the most recent guidelines on this cancer type. This guide for patients is a service to patients and their families, to help them understand the nature of the disease and the existing treatment choices. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of disease. This Guide for Patients in particular has been produced in collaboration with the European Society for Medical Oncology (ESMO) and is disseminated with its permission. It has been written by a medical doctor and reviewed by two oncologists from ESMO including the lead author of the clinical practice guidelines for professionals. It has also been reviewed by patients’ representatives from ESMO’s Cancer Patient Working Group.

Frequency

This text is currently being updated.

Causes

This text is currently being updated.
PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES
As treatments are becoming more personalized due to the advances in cancer care, we would kindly ask you to contact info@anticancerfund [dot] org for a more appropriate guidance according to the most recent guidelines on this cancer type. This guide for patients is a service to patients and their families, to help them understand the nature of the disease and the existing treatment choices. 

 

What causes melanoma?

Today, it is not clear why melanoma occurs. Some risk factors have been identified. A risk factor increases the risk that cancer occurs, but is neither necessary nor sufficient to cause cancer. A risk factor is not a cause in itself.

Some people with these risks factors will never develop melanoma and some people without any of these risk factors will develop melanoma.

The main risk factors of melanoma are:

  • Skin type: people with fair skin have a higher risk of developing melanoma than people with darker skin. The highest risk concerns people with red hair and freckles. Melanoma is actually very rare in black or Asian people. When it does occur it is usually a special type of melanoma called acral lentiginous melanoma occurring on the palms, soles or under the nails.
  • Naevi: a naevus is the medical term for a mole. The majority of moles will never turn into cancer, but the presence of many (more than 100) moles or unusual moles indicates an increased individual risk of developing melanoma.

    Other factors, such as exposure to pesticides or having Parkinson’s disease are suspected to be associated with an increased risk of melanoma, but evidence of and reasons for these associations remain unclear.
     

    • Having multiple common naevi (like the one in the picture on the right) increases the risk of developing melanoma. The risk increases with the number of naevi and is particularly high when the number of naevi is above 100.
    • Having 3 or more atypical naevi increases the risk of developing melanoma. An atypical naevus is defined as a naevus presenting at least 3 of the ‘ABCD’ characteristics: Asymmetry in its shape, Border irregularity or a border which is ill-defined, Colour varying from one area to another and Dynamic evolution over time regarding its shape, colour or size.
    • Congenital naevi are moles that are present from birth. Large (>5cm) congenital moles are at risk of turning into melanoma. Persons with large congenital naevus should be followed up on a regular basis.
    • Sun exposure: natural exposure to ultraviolet (UV) radiation emitted by the sun is an important risk factor for melanoma. The following factors increase the risk at every stage of life but are worse when exposure occurs in early childhood.
      • Intermittent sun exposure, usually for recreational purposes, increases the risk of developing melanoma.
      • Sunburn increases the risk of developing melanoma, especially sunburns during childhood.
      • Using sunscreen may reduce the risk of developing melanoma. It should be associated with other simple rules such as avoiding being in the sun between 11 am and 3 pm, and covering up with clothes, a broad hat and sunglasses when exposed to the sun.
    • Sun bed use: exposure to artificial UV light to get a tan increases the risk of developing melanoma especially when sun beds are used before the age of 30.
    • History of melanoma
      • Having had melanoma increases the risk of having another melanoma at a different location
      • Having a first-degree relative (parents, siblings and children) who had melanoma increases the risk of having melanoma. Some inherited gene mutations are known, such as the CDKN2A mutation, but gene mutations are found in less than 50% of the melanoma families.
    • Age: the risk of melanoma increases with age although melanoma is less associated with aging than other types of cancer and it can occur in people who are under the age 30.
    • Gender: in North-America, Oceania and Israel men have a higher risk of developing melanoma while in Europe the risk is slightly higher in women.
    • Immune suppression: people with lowered immunity are at a higher risk of developing melanoma. Immunity can be lowered because of a disease such as AIDS or because of drugs given after an organ transplant.
    • Xeroderma pigmentosum: it is a rare and inherited disease in which the ability to repair damage caused by ultraviolet light is impaired. For these people, the risk of developing all types of skin cancers including melanoma is extremely high.

Diagnosis

This text is currently being updated.

 

PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES
As treatments are becoming more personalized due to the advances in cancer care, we would kindly ask you to contact info@anticancerfund [dot] org for a more appropriate guidance according to the most recent guidelines on this cancer type. This guide for patients is a service to patients and their families, to help them understand the nature of the disease and the existing treatment choices. 

Melanoma is usually diagnosed after a suspicious mole is noticed by the patient, a relative or a doctor. This can happen during a screening or routine skin examination, especially for people with fair skin, red hair, a tendency to burn in the sun and multiple naevi.

The diagnosis of melanoma is based on the following examinations:

  1. Clinical examination

The doctor asks the patient questions, especially regarding possible risk factors, and about the evolution of the suspicious mole(s). Examination of the suspicious mole(s) and of the rest of the skin is also done. As mentioned above, a suspicious mole presents the ‘ABCD’ characteristics:

• Asymmetry in its shape

• Border irregular or a border which is ill-defined

• Colour varying from one area to another

• Dynamics

Not all melanomas present the 4 characteristics altogether. There are even melanomas without dark colors that present as reddish pimples. In addition, the doctor also feels the lymph nodes in the groin, armpit, neck, etc. depending on the location of the suspicious mole(s).

2. Dermoscopy

This consists of using a small device called dermoscope or dermatoscope which illuminate and magnify the spots on the skin for a more precise examination. Even if examination with a dermoscope is not always necessary, it enhances the accuracy of diagnosis when performed by an experienced doctor trained to use this technique.

3. Histopathological examination after removal of the whole mole.

A histopathological examination is the laboratory examination of the tumor cells by dissecting the tumor. This will confirm the diagnosis of melanoma. The tumor has to be cut out completely and then sent to the laboratory. This is called a skin biopsy and is done manually by the doctor. First, a local anaesthetic is injected into the area that is going to be removed. Then, the suspicious mole is removed ensuring a certain margin of normal tissue around and under the tumor is also removed. It is very important that both removal of the mole and laboratory examination are performed by professionals with experience in the treatment of melanoma.

Treatment

This text is currently being updated.

Synonyms

Melanoma

Melanoma of the skin

Malignant Melanoma

Cutaneous Melanoma

Skin cancer

Skin tumour

Skin tumor

Cancer of the skin

Tumour of the skin

Tumor of the skin

Therapies by type

The following list of treatments is based on what we have found in scientific studies about cancer. More information about the listed therapies can be found under the tab THERAPIES. For registered drugs, radiotherapy and surgical interventions, approval by the authorities is given.

Surgical interventions

Procedures involving instrumental means to investigate or treat a cancer, or to improve the body’s functions or appearance. Generally, a surgical intervention involves an incision. More

Radiotherapy

Medical use of high-energy radiation to kill cancer cells and reduce tumor size. More

Cell-based therapies

Administration to patients of their own or someone else’s manipulated human cells. More

Synthetic products (excluding registered drugs)

Synthetically produced substances or modified natural products that are not registered as anti-cancer drugs.

Natural products (excluding registered drugs)

Substances found in nature that usually have a pharmacological or biological activity. More

Diets

Controlled consumption of carefully selected foods and beverages with the intent to influence disease outcome.

Energy based therapies

Use of electromagnetic energy including electricity, magnetic fields, radio waves, microwaves, infrared rays and light to diagnose or treat disease.

Clinical trials

A clinical trial is a research study conducted with patients to evaluate whether a new treatment is safe (safety) and whether it works (efficacy). Clinical trials are performed to test the efficacy of drugs but also non-drug treatments such as radiotherapy or surgery and combinations of different treatments. Clinical trials take place in all kinds of hospitals and clinics, but mostly in academic hospitals. They are organized by researchers and doctors.

The Anticancer Fund provides a tool to search for phase III clinical trials by type of cancer and by country. Discuss the possibilities of participating in one of these clinical trials with your doctor.

The list of the phase III clinical trials for skin cancer-melanoma is available here.

You can find a list of personalized treatments for melanoma, including clinical trials, here.