Melanoma

Melanoma starts when normal melanocytes become cancerous. When cancer cells are on the skin, the cancer is called cutaneous melanoma. Most of what we know about melanoma (its behavior, staging, and treatment) refers to cutaneous melanoma.

Types of Cutaneous Melanomas

• Superficial spreading. This is the most common form, making up about 70 percent of all cutaneous melanomas. These often grow along the skin for a long time before invading the skin more deeply. They often have irregular shapes and are several shades of brown or other colors, such as black, blue, or red.
• Nodular. These are often black, dome-shaped lesions. They tend to grow vertically, into deeper skin layers.
• Acral lentiginous. These are found on the palms of your hands, soles of your feet, under a nail (subungual), or on mucous membranes, such as the mouth, rectum, or vagina (mucosal). This type makes up a larger portion of melanomas in people with naturally darker skin.
• Lentigo maligna. These are common in older people. They are typically flat and large, spreading widely along the surface of the skin. They often begin as benign lesions on the face or other sun-exposed area.
• Desmoplastic or neurotropic. These melanomas show up as small nodules on the skin, which are non-pigmented (light in color). They can travel and grow along nerves in the skin and can cause fibrous tissue to develop.
• Amelanotic melanoma. These melanomas are often pink or flesh-colored. They are variants of the more common melanomas because they don’t make pigment. As a result, they can be mistaken for a pimple or other noncancerous growth.

Melanoma Growth and Spread

If melanoma grows at the site of the original tumor, it tends to grow in one of two ways:

• Radial growth. This means the melanoma spreads horizontally along the top layers of your skin. Most melanomas start growing this way, but some may eventually grow into deeper layers of your skin.
• Vertical growth. This means melanoma grows into deeper layers of skin. This kind of growth is more serious and may spread to other parts of the body. Nodular melanoma grows this way fairly quickly, but most others grow along the top layers of skin first for some time.

• Age. Melanoma is more common in older people.
• Gender. Men have a higher risk for melanoma, but women have a higher risk before age 40.
• Sun exposure. Sunlight is a major risk factor for melanoma (and other skin cancers).
• Artificial tanning. The use of tanning beds and sunlamps has been linked to an increased risk of melanoma.
• Moles. While most moles are harmless, people who have many moles or abnormal moles (called dysplastic nevi) are at increased risk for melanoma.
• Fair skin, light hair. People with light skin are many times more likely to develop melanoma than those with darker skin.
• Family history. People whose parents or siblings have had melanoma are at higher risk of melanoma.
• Certain inherited conditions. People with certain rare, inherited conditions, such as xeroderma pigmentosum (XP), are at increased risk for melanoma.
• Personal history. People who have had melanoma before are more likely to develop it again.
• Weakened immune system. People who have a weakened immune system, such as people who have had an organ transplant, are at higher risk of melanoma.

Learn more about risk factors for melanoma.

The first symptom of melanoma is usually a change in a mole or the appearance of a new mole that has ABCDE characteristics. These ABCDE rules can help you tell a normal mole from cancer.

The ABCDE rules are:

• Asymmetry. One half of the mole does not match the other half.
• Border irregularity. The edges of the mole are ragged or irregular.
• Color. The mole has different colors in it. It may be tan, brown, black, red, or other colors. Or it may have areas that appear to have lost color.
• Diameter. The mole is bigger than 6 millimeters across, about the size of a pencil eraser. But some melanomas can be smaller.
• Evolving. A mole changes in size, shape, or color.

Learn more about symptoms of melanoma.

Your health care provider will examine you with the ABCDE rules in mind (see above) and will ask about the moles on your skin:

• If one hurts or itches
• If one oozes fluid or bleeds, or gets crusty
• If one has changed in size, color, or shape

Make sure to tell your health care provider if you’ve had skin cancer in the past. Also note whether anyone in your family has had skin cancer.

Biopsy

Your health care provider will likely take a biopsy of any mole or other skin mark that may look like cancer.

The different types of biopsies include the following:

• Excisional biopsy. Used when a wider or deeper piece of the skin is needed and when a melanoma is suspected. The entire mole and part of the surrounding skin is removed.
• Incisional biopsy. This procedure is the same as an excisional biopsy. But only part of the mole or mark is removed.
• Punch biopsy. This type uses a special tool to take a deep sample of skin. The tool removes a short cylinder of tissue, like an apple core.
• Shave biopsy. This type of biopsy removes the top layers of skin shaved off with a scalpel. This method may be used on a mole if the chance if melanoma is very low.

Learn more about melanoma diagnosis.

The biopsy and other tests will help your doctor determine the extent of melanoma, called its stage. Melanoma may be located in one specific area of the skin, but it can move quickly to the lymph nodes. Your treatment plan and chance for a good outcome--called the prognosis--depend on the stage of your melanoma. They also depend upon your general health, the location of the tumor, and other factors.

Learn more about melanoma staging.

The melanoma surgical specialists at BWH along with their colleagues at the Melanoma Treatment Center at the Dana-Farber Brigham Cancer Center focus exclusively on melanoma treatment and research.

You may have just one treatment, or a combination of treatments.

• Surgery. The goal of surgery is to remove the melanoma, while leaving as much of the nearby skin as intact as possible. The BWH surgical oncologists are the surgical team at the Center for Cutaneous Oncology at the Dana-Farber Brigham Cancer Center.
• Radiation therapy. The goal of radiation is to destroy cancer cells. It may be used after surgery to try to kill any cancer cells that are left. It may also be used to help treat melanoma that has come back after initial treatment or has spread to other parts of the body.
• Chemotherapy. The goal of chemotherapy is to destroy cancer cells directly to shrink tumors that can’t be removed by surgery. Chemotherapy is done with medications.
• Biological therapy. The goal of biological therapy is to shrink advanced melanoma tumors by using your body’s immune defense to attach cancer cells. This type of therapy is done with medicines that affect the immune system. It is also called immunotherapy, antibody therapy, or vaccine therapy.
• Targeted therapy. The goal of targeted therapy is to shrink advanced melanoma tumors with medicines which target specific parts of melanoma cells.

Learn more about treatment for melanoma.

Learn more about immunotherapy for melanoma treatment.

You will receive a thorough diagnostic examination to evaluate your condition and determine what course of treatment is needed. Careful monitoring and the involvement by an experienced surgical oncologist is important to the successful outcome for patients with advanced or complex melanoma.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with melanoma. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

The surgical specialists at BWH along with their colleagues at the Melanoma Treatment Center at the Dana-Farber Brigham Cancer Center provide the world’s most advanced and innovative multidisciplinary care for patients with melanoma. Our treatment team includes surgical oncologists, medical and radiation oncologists, plastic surgeons, nutritionists, pathologists and anesthesiologists. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Learn more about risk factors for melanoma in our health library.

Read more about melanoma diagnosis in our health library.

Learn more about immunotherapy for melanoma treatment in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Visit the Weiner Center for Preoperative Evaluation.

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