Melanoma Skin Cancer Treatment

Melanoma is one type of skin cancer. It can happen anywhere on your body — including on the palms of the hands, bottoms of the feet and under the nails.

While it is not as common as other types of skin cancer (1% of skin cancers are melanoma) melanoma is more aggressive and is more likely to spread to other parts of the body, including the lymph nodes, lungs, liver, bones or brain. It can grow very quickly and, in the most advanced stage, become life-threatening in as little as six weeks. But melanoma is highly curable when discovered and treated in its earliest stages.

Can you survive melanoma? 

All stages of melanoma are potentially survivable. The prognosis for survival is measured by the percentage of people alive after five years who have the same type and stage of melanoma. However, no two people are alike, and people have different responses to treatment. Overall, about 94% of people treated for melanoma are still alive five years after diagnosis (NCI SEER data, 2014-2020). That percentage varies by stage of melanoma: 

• 100% survival for localized melanoma — The melanoma has not spread beyond the location where it started. About 77% of people are diagnosed at this stage.
• 74.8% survival for regional melanoma — The melanoma has spread to regional lymph nodes (nodes in the region around the tumor). About 10% of people are diagnosed at this stage.
• 35% survival for distant melanoma — The melanoma has metastasized or spread to other areas of the body. About 5% of people are diagnosed at this stage. 

Doctors don’t usually say melanoma is curable, because there is a chance for any stage of melanoma — even melanoma treated at an early stage — to come back, known in medical terms as “recurrence.” If it comes back, it is most likely to happen within the first five years after treatment. 

When melanoma does not come back within 10 years after treatment, it is less likely to return but there have been cases of melanoma returning even after 25 years. For this reason, it is vital to get regular check-ups and imaging scans as recommended by your doctor. You should also to do monthly skin self-checks. If you notice changes, call your doctor right away.

If you notice changes in existing moles or you develop new areas of skin that look unusual in color, shape, size or texture, it is important to contact your doctor right away.

Although melanoma can develop from a common mole, it is uncommon for it to do so. Melanoma begins in cells within the skin and eyes that produce melanin, which provides the pigment (color) of your eyes, hair and skin. The more melanin you produce, the darker your eyes, hair and skin. Genetics play a significant role in melanin production, as well, so it is possible to have dark eyes and hair while also having fair skin.

Causes of Melanoma

Ultraviolet light from the sun or tanning beds cause cancer by damaging our DNA. Your skin can repair the damage but over time, it becomes less able to do so, and changes can develop in skin cells that lead to melanoma.

It is rare to for melanoma to run in families, but some people can inherit genes that make them more likely to develop it.

Who Has the Greatest Risk of Developing Melanoma

It affects men and women but the incidence is different: Women are at higher risk before age 50, while men have a higher risk of developing the disease after age 50. Men are also more likely to die of melanoma than women. Another gender difference is where melanoma develops. In women, it is more often discovered on the back or lower legs. Men more typically get melanoma on the back, head or neck.

People with darker skin tones can develop melanoma and are more likely to be diagnosed with melanoma at later stages. It tends to develop underneath or around the nails, on the bottoms of the feet or on the palms of the hands. In these cases, it is unlikely to have developed from exposure to ultraviolet light.

Melanoma Risk Factors

• Frequent sun exposure without protecting your skin with clothing or sunscreen
• Using tanning equipment like tanning beds
• Blistering sunburns
• Fair skin
• Light-colored eyes
• Blond or red hair (naturally occurring)
• Weakened immune system
• Organ transplant recipient

Having certain types of cancer increase the risk of developing melanoma, such as a previous melanoma or other skin cancers).

What Melanoma Looks Like

Melanoma can appear as a change in how a mole you already have looks (increase in size, change in color, shape, feel) or it can be a new area on the skin that looks and feels different. When melanoma becomes advanced, it can bleed, itch become painful or look raw or scraped.

It may help to think of the features of melanoma as A, B, C, D and E:

• Asymmetry: One half doesn’t look the same as the other in shape 
• Border: Border has ragged, uneven edges
• Color: Multiple colors, including black, brown, tan, white, gray, red, pink or blue
• Diameter: Melanomas can be very small or large, such as ¼ of an inch wide. 
• Evolving: When a mole has changed over weeks or months, it could be melanoma

Diagnosing Melanoma Skin Cancer

If your doctor suspects you have melanoma, you will be referred to a dermatologist, who will examine your skin and look at it with specialized devices. If melanoma is suspected, the dermatologist will remove the abnormal area and a small amount of tissue around it, and send it to a lab. A pathologist will test the biopsied tissue to determine if it is melanoma. If it is, the pathologist will measure the depth of the invasion. Melanoma is staged based on the tumor’s thickness, and whether or not it has spread to the lymph nodes or other areas in the body.

Tissue samples may be tested for changes in specific genes, which can influence the type of treatment that will work best. The stage of the melanoma will also help determine treatment. Melanoma can be early stage — stage 0, is very superficial and not invasive. It can also be stage I, II, III or IV. Stages I and II are when the melanoma is still confined to just the one spot in the skin. Stage III is when the melanoma has spread to the local lymph nodes, and stage IV is when it has spread to other areas of the body.

If the melanoma is thicker and likely to spread, other tests are needed. These could include lymph node mapping, imaging scans and a blood test to check for an enzyme called lactate dehydrogenase or LDH.

Melanoma Skin Cancer Treatment

Even for the most advanced stages of melanoma, it is not too late to consider treatment. Depending on individual factors, it is possible to live for years after treatment. Radiation therapy, targeted therapy, immunotherapy and clinical trials can be used to treat melanoma that has spread throughout the body.

Your cancer team will recommend a treatment plan based on your cancer’s stage.

Surgery

Surgery is the first line of treatment for earlier stage melanoma and is performed by a surgical oncologist. It involves removing the melanoma, as well as a wide area of skin around the melanoma. If needed, skin is removed from another area of the body to cover the wound.

Depending on your cancer’s stage, your treatment team may recommend medications to eliminate any stray cancer cells left behind after surgery. Other treatments include:

Radiation Therapy

Radiation therapy shrinks tumors that have spread beyond the original site of the melanoma to other areas such as the brain, spinal cord, lungs or bones. It can also relieve symptoms caused by the melanoma. Sessions last 10 to 20 minutes, and the number of sessions you receive will depend on your tumor’s size and where it is in your body. As with radiation therapy for other types of cancer, there can be side effects including skin problems, fatigue, loss of hair and nausea. Tell your radiation oncologist right away if you are experiencing these side effects, as there are remedies to help.

Immunotherapy 

Immunotherapy helps activate the immune system to find and eliminate cancer cells.

Targeted Therapy

Targeted therapy uses drugs or other agents to target specific molecules that cancer cells need to grow.

Vaccine Therapy

Vaccine therapy stimulates the immune system to attack invaders like cancer cells, bacteria or viruses.

Clinical Trials

Clinical trials may combine standard therapies with immunotherapies or targeted therapies. They are completely voluntary and, in some cases, clinical trials may be the best way to treat your melanoma. Ask your doctor if there is a clinical trial that could help you.