Melanoma: Overview

What Increases Your Risk for Melanoma?

Should you worry about melanoma? Oncologist Dr. Anna Pavlick tells SurvivorNet which factors could increase your risk for this cancer.

Risk factors are things that make you more likely to get cancer. In the case of melanoma, both your genes and things you're exposed to in your environment can increase your risk, like:

• Being fair-skinned
• Having blond hair and blue eyes
• Having a family history of skin cancer
• Having many moles all over your body
• Being diagnosed with melanoma in the past
• Frequenting  indoor tanning salons

Having these factors doesn't mean that you'll definitely get melanoma. In fact, odds are that you won't. But they do slightly increase your odds.

And while you can't control the color of your skin or eyes, or the genes you've inherited, you can avoid sunbathing and indoor tanning salons. Ultraviolet (UV) radiation from the sun and indoor tanning beds are the leading causes of this cancer.

Also, if you have any of these risks, it's even more important that you see your dermatologist for regular skin checks, as well as do your own skin checks to look for any new or changing spots.

What Are the Symptoms of Melanoma?

The most important thing to look out for when it comes to finding melanoma is a new spot on your skin, or a spot that is changing in size, shape, or color, SurvivorNet’s medical experts say. The spot will likely also look different from all of the other spots on your skin (doctors call this the "ugly duckling sign").

When checking for melanoma, remember your ABCDEs

When you check your skin, use the acronym ABCDE as your guide:

• Asymmetrical moles: If you drew a line straight down the center of the mole, would the sides match?
• Borders: Is the mole irregular or jagged?
• Colors: Are there multiple distinct colors in the mole?
• Diameter: Is the mole larger than 6 millimeters (mm), about the size of a pencil head eraser?
• Evolution: Has the mole's color, shape, or size changed over time?

If you answered "yes" to any of these questions, our experts say it’s time to see your dermatologist for a skin check.

Other red flags to watch for are:

• A sore that doesn't heal
• Color that spreads from the border of a spot to the skin around it
• Redness or swelling that goes beyond the area of a mole
• Itchiness, tenderness, or pain
• A change in the way the surface of a mole looks
• Scaliness, oozing, or blood

Getting a Diagnosis

Unlike with other diseases, the workup for melanoma is pretty straightforward and simple. If you spy a suspicious growth or mole, and/or you want to get evaluated for any worrisome spots on your body, your dermatologist will do a head-to-toe visual examination of your skin.

If a growth warrants further evaluation, you might get a biopsy, which just means removing a tiny piece of skin and sending it to a lab to test for cancer. A biopsy will rule out or confirm whether you have melanoma.

If your doctor happens to detect an advanced melanoma, you may need to have imaging and blood tests done. This will allow your dermatologist to zero in on a specific diagnosis and determine your treatment plan.

The way that melanoma spreads is a bit different than other cancers. Rather than spread directly to other organs, it spreads to the different layers that make up your skin. The higher your stage of melanoma, the deeper it has spread into the layers of your skin, and the more serious your cancer is.

Your doctor will stage your melanoma based on how deep the cancer has gone into your skin.

How does your doctor figure out your cancer stage? Medical oncologist Dr. Anna Pavlick explains.

• Melanoma in situ is a stage zero melanoma that's commonly found on the top layer of sun-damaged skin. It is highly treatable with surgical removal, and it does not usually invade beyond the skin or spread to other organs.
• Stage I melanoma is no bigger than the size of a sharpened pencil. It's easily cured by having a dermatologist remove it.
• Stage II melanoma has spread slightly deeper into the skin.
• Stage III melanoma has spread into the lymph nodes.
• Stage IV is when the melanoma has reached other organs, like the lungs, liver, or brain.

Knowing the stage and other characteristics of your cancer will help your doctor zero in on the right treatment for you.

Melanoma Treatment Options

Melanoma treatment has come a long way. Survival rates have risen dramatically, thanks to a “treatment revolution,” say SurvivorNet’s experts. With breakthrough treatments like targeted therapy and immunotherapy now available, people who are diagnosed today have a much better chance of living a long and healthy life than ever before.

If you're diagnosed with melanoma, there's a good chance surgery is going to be the treatment your doctor recommends. In the early stages of the disease, removing the cancer should lead to a cure. The question is typically not whether you'll get surgery, but which kind you'll have.

Dermatologic surgeon Dr. Nima Gharavi, on why surgery is the “gold standard treatment” for melanoma

For an early-stage melanoma that is close to the skin surface, Mohs surgery might be an option. This technique removes skin cancer, layer by layer, until all the cancer is gone.

In general, stage I melanoma surgery consists of the simple, in-office removal of the cancerous cells by a dermatologist. If the cancer is thicker, your surgeon will remove it through a technique called wide excision surgery.

The removal of stage II and III melanomas are performed by surgeons or surgical oncologists, not dermatologists. You may also have a sentinel lymph node biopsy to see if the melanoma has spread to the first lymph node where it's most likely to travel. If your cancer has reached this first lymph node, it may have spread to other neighboring lymph nodes, and possibly to other organs. Where the cancer is will dictate your treatment.

After surgery, the removed tissue and lymph nodes will go to a specialist called a pathologist, who will measure the melanoma and find out if it has clear margins. Having clear margins means the cells around the area of tissue that was removed don't contain any melanoma. When there aren't any cancer cells left around the removed area, your cancer is less likely to come back.

Is Surgery Covered by Insurance?

Some patients are worried that surgery for skin cancer may not be covered by insurance because it could be considered a cosmetic procedure. However, experts tell us that most skin cancer surgeries are covered.

“Most surgery is covered by most insurance,” Dr. Jesse Lewin, System Chief of the Division of Dermatologic & Cosmetic Surgery at Mount Sinai, tells SurvivorNet. “…Even though the reconstruction is done in a cosmetically-sensitive way, it’s not a cosmetic procedure.

“[Patients] are not billed for a cosmetic procedure after the skin cancer is removed. One of the main advantages is you can see one surgeon who is trained in removing the cancer, looking under the microscope, and doing the reconstruction. So, you’re in one place … [and] awake for an outpatient procedure to cure your skin cancer.”

Later-Stage Melanoma Treatment

Once your cancer spreads, treatment gets a little more complicated, but there are still ways to stop it. New treatments have vastly improved the outlook for people with metastatic, or stage IV, melanoma.

There’s no “cookie cutter” recipe for treating stage IV melanoma, as Dr. Anna Pavlick explains

Targeted drugs block proteins and other substances the cancer needs to grow, while immunotherapy boosts your body's own response to help it fight the cancer better. With so many more choices available, treatment can be tailored to you. These therapies are more likely than chemotherapy to control your cancer, but like any treatment they can cause side effects.

Immunotherapy drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) can help some people with this cancer live longer. Whether these drugs are right for you depends on a number of factors, including where the melanoma is and how fast it's spreading. Combining immunotherapy drugs might also extend survival. But again, these treatments have risks that are important to discuss with your doctor.

How immunotherapy helped one woman beat aggressive melanoma

There's also a vaccine that has been approved by the U.S. Food and Drug Administration for people whose melanoma has spread and can't be removed with surgery. Talimogene laherparepvec (T-VEC) is a modified herpes virus that kills cancer cells when doctors inject it directly into the cancer.

Researchers, including some of SurvivorNet’s own experts, are studying other groundbreaking melanoma treatments in clinical trials. Enrolling in one of these studies might give you access to a new treatment before it's available to everyone else.

Once you’ve finished treatment for melanoma, it can come with a huge sense of relief. Celebrate your successes, but stay vigilant. It is possible for this cancer to come back in the future. Whether your cancer is likely to return may depend on your stage, so screening recommendations vary. If you had early-stage melanoma, you should have a skin exam once every three to six months.

If you had late-stage melanoma, in addition to regular skin exams every three to six months, you may also need imaging scans or blood tests to monitor for signs of recurrence. You should also report any symptoms such as a headache, changes in vision, cough, fatigue, or weight loss to your doctor.