Melanoma

This is a serious form of skin cancer – often known as malignant melanoma – which develops as a result of too much exposure to the sun. It is curable as long it is caught at an early stage but this decreases the longer it is left untreated. Unfortunately this disease can be fatal.

Why is this serious?

The main problem with melanoma is its ability to spread to other areas of the body. If it invades other organs then it is known as metastatic cancer. And if that continues to an advanced stage then the outlook is bleak.

Is melanoma a common form of skin cancer?

It accounts for 10% of skin cancer cases www.nhs.uk/conditions/Malignant-melanoma.

It is fairly rare but is still the main cause of death from skin cancer in the UK. Melanoma develops as a result of over exposure to the sun or excessive use of a sunbed.

Causes of melanoma

Before we discuss the cause here is a brief overview of cancer:

Cancer is caused by abnormal cell division; the cells within your body grow and divide in a normal manner which enables your body to function as it should.

But something goes wrong with this process which causes the cells to multiply at an uncontrolled rate. These cells invade nearby tissue or organs where a growth of cells or tumour develops. This tumour increases in size and can spread to other organs or throughout the lymphatic system.

Cancer will develop in any part of the body where there is abnormal cell division.

But melanoma is caused by excessive exposure to sunlight in the form of sunbathing or using a tanning salon. Sunlight contains ultraviolet (UV) A and B rays which damage the skin over a period of time.

There are several risk factors for melanoma which include:

  • Having a Celtic type of skin, e.g. very white skin and red hair
  • Having fair skin and blue eyes
  • Having the type of skin which always burns and never tans
  • Having lots of freckles
  • Having lots of moles
  • If someone in your family has had melanoma (inherited)

Plus if you are taking any medication which has suppressed your immune system or have an autoimmune disorder.

Symptoms of melanoma

The most obvious sign is a change in an existing mole, for example, a mole which has suddenly increased in size or has an irregular shaped border.

Another warning sign is the appearance of a new mole which also displays these changes.

Other warning signs include:

  • A mole which is itchy and may bleed
  • A mole which is asymmetrical
  • A mole with a ragged edged border
  • A mole which is comprised of two colours
  • A mole which is bigger than a quarter of an inch
  • A mole which is raised above the surface of the skin: this mole may stay the same but the area underneath it spreads or swells.

Basically, if you have a mole or several moles and are concerned about their condition then speak to your GP.

The NHS Choices website contains a section about skin cancer (melanoma) which includes an ABCDE checklist for moles www.nhs.uk/conditions/Malignant-melanoma.

Diagnosing melanoma

Your GP will examine your skin, closely looking at the suspicious mole/s before referring you to a dermatologist. The dermatologist is a specialist in skin conditions who will carry out a skin biopsy to determine if the mole is cancerous or not.

The mole is removed from your skin via a local anaesthetic and examined under a microscope. If melanoma is confirmed then the area surrounding the mole is removed and any other affected areas. This is particularly the case if you have cancer which has spread to other areas of your body. It can invade tissues, organs and the lymphatic system.

This is why it is important that the cancer is detected earlier rather than later.

If the dermatologist suspects that cancer has spread to the lymph glands then he/she will perform a ‘sentinel lymph node biopsy’. A lymph node is another name for the lymph glands.

Lymph glands

What are lymph glands? These are glands that form part of your immune system and enable fluid in the skin to move around the body. You may have noticed the glands in your neck swelling up each time you have a cold or similar infection.

Melanoma can spread to any of the lymph glands irrespective of their position in the body. For example, if you have a malignant mole on the top of your arm then this cancer will spread to the lymph glands within your armpits.

Sentinel lymph node biopsy

A liquid containing a blue dye and a radioactive chemical is injected into the area surrounding the suspicious mole. This liquid passes through the skin in the same way the melanoma would until it reaches the first lymph gland or ‘sentinel lymph node’.

The sentinel lymph node is removed and examined under a microscope for signs of melanoma. If this is clear then the chances are that the rest of the lymph glands will be the same. But there are a few exceptions to this.

But if the sentinel lymph node shows signs of melanoma then there is a fair chance that it will have spread to another lymph gland. If this is the case then the infected lymph glands will also be removed.

Other tests

You will also be referred for other tests such as blood tests, x-rays and CAT/MRI scans.

Treatment for melanoma

Melanoma is treated by a team of professionals which includes an oncologist (cancer specialist), specialist nurses, pathologist and/or radiologist. They apply a multi-disciplinary approach to your treatment, taking into account your overall health, extent of your melanoma and the likely outcome. Melanoma like all other cancers is graded according to how far it has spread. This enables the team to determine the extent and the appropriate treatment.

Cancer is graded in stages 1 to 4 but this differs for skin cancer. Skin cancer uses stages 0 to 4 with sub-stages in between. Stage 0 is used to grade skin cancer only and means that cancerous cells are present but they have not spread to any other area of the body. Stage 1 is a mild form of melanoma through to stage 4 which means that the melanoma is widespread and secondaries have formed.

The treatment you receive depends upon what stage your melanoma is at.

Treatment options include:

  • Surgical removal of the mole/s
  • Surgical removal of the lymph nodes
  • Chemotherapy
  • Radiotherapy
  • Medication, e.g. monoclonal antibodies

Whatever treatment you choose will be discussed between your and your team. They will act with your best interest at heart and will respect whatever decision you make. An example of this are people with stage 4 melanoma which is no longer responding to treatment and have decided to stop further treatment. The issue then is palliative care.

Complications of melanoma

If you have suffered with melanoma before then there is a risk of a recurrence. This is particularly the case if you had a severe form of this disease. You will be advised to check your skin (and moles) on a regular basis and avoid sunbathing.

Preventing melanoma

Melanoma is not automatic and with a few precautions, it can be prevented. The main factor is sun or to be more precise, too much exposure to the sun which damages the skin.

Avoid sunbathing at the hottest time of the day (midday), wear loose cotton clothing and use a suncream with a high sun protection factor (SPF). Apply this on a regular basis even after being in the water. Try to avoid sunburn. Wear a hat and sunglasses to protect your head and eyes especially if you have an outdoors job.

Avoid using a tanning salon or sunbed/sunlamp at home but if you do then minimise your time spent under these. Take into account the type of skin you have, e.g. fair skin and err on the side of caution.

And get into the habit of checking your moles on a frequent basis. Moles are discussed in more detail as a separate section.