Melanoma


General Information

What is melanoma?

Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).

Melanocytes are found throughout the lower part of the epidermis. They produce melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes produce more pigment, causing the skin to tan, or darken.

The skin is the body's largest organ. It protects against heat, sunlight, injury, and infection. The skin has 2 main layers: the epidermis (upper or outer layer) and the dermis (lower or inner layer).

When melanoma starts in the skin, the disease is called cutaneous melanoma. This summary is about cutaneous (skin) melanoma. Melanoma may also occur in the eye and is called ocular melanoma or intraocular melanoma. (Refer to Intraocular Melanoma Treatment for more information.)

There are 3 types of skin cancer:

-Melanoma.
-Basal cell skin cancer.
-Squamous cell skin cancer.

Melanoma is more aggressive than basal cell skin cancer or squamous cell skin cancer. (Refer to Skin Cancer Treatment for more information on basal cell and squamous cell skin cancer.)

Melanoma can occur anywhere on the body. In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the arms and legs. Melanoma usually occurs in adults, but it is sometimes found in children and adolescents.

Unusual moles, exposure to sunlight, and health history can affect the risk of developing melanoma.

Risk factors include the following:

-Unusual moles.
-Exposure to natural sunlight, including sunburns during childhood.
-Exposure to artificial ultraviolet light (tanning booth).
-Family or personal history of melanoma.
-Red or blond hair.
-White or light-colored skin and freckles.
-Blue eyes.

Possible signs of melanoma include a change in the appearance of a mole or pigmented area.
These and other symptoms may be caused by melanoma or by other conditions. A doctor should be consulted if any of the following problems occur:

A mole that:

-changes in size, shape, or color.
-has irregular edges or borders.
-is more than 1 color.
-is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).
-itches.
-oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the underlying tissue shows through).
-Change in pigmented (colored) skin.
-Satellite moles (new moles that grow near an existing mole).

Tests that examine the skin are used to detect (find) and diagnose melanoma. If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help detect and diagnose melanoma:

Skin examination: A doctor or nurse examines the skin to look for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.

Biopsy: A local excision is done to remove as much of the suspicious mole or lesion as possible. A pathologist then looks at the tissue under a microscope to check for cancer cells. Suspicious areas should not be shaved off or cauterized (destroyed with a hot instrument, an electrical current, or a caustic substance).

Certain factors affect treatment options and prognosis (chance of recovery). The treatment options and prognosis (chance of recovery) depend on the stage of melanoma (whether cancer is found in the outer layer of skin only, or has spread to the lymph nodes or to other places in the body), whether there was bleeding or ulceration at the primary site, the location and size of the tumor, and the patient's general health. Although many people are successfully treated, melanoma can recur (come back).

Stages of Melanoma

After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.

The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following tests and procedures may be used in the staging process:

Wide local excision: A surgical procedure to remove some of the normal tissue surrounding the area where melanoma was found, to check for cancer cells.

Lymph node mapping and sentinel lymph node biopsy: Procedures in which a radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes (the first lymph node or nodes where cancer cells are likely to have spread). The surgeon removes only the nodes with the radioactive substance or dye. A pathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes.

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma, pictures may be taken of the chest, abdomen, and pelvis.

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI). In melanoma, an MRI of the brain may be done.

PET scan (positron emission tomography scan): A PET scan creates a picture showing the location of tumor cells in the body. A substance called radionuclide glucose (sugar) is injected into a vein and the PET scanner rotates around the body to create the picture. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

Laboratory test: A medical procedure that involves testing a sample of blood, urine, or other substance from the body. Tests can help determine a diagnosis, plan treatment, check to see if treatment is working, or monitor the disease over time.

The results of these tests are viewed together with the results of the original tumor biopsy to determine the melanoma stage.

The following stages are used for melanoma:

Stage 0
In stage 0, melanoma is found only in the epidermis (outer layer of the skin). Stage 0 is also called melanoma in situ.

Stage I
Stage I is divided into stages IA and IB.

Stage IA: In stage IA, the tumor is not more than 1 millimeter (less than 1/16 of an inch) thick, with no ulceration (a hole that forms in the skin when the top layer of cells breaks down and the underlying tissue shows through). The tumor is in the epidermis and upper layer of the dermis.
Stage IB: In stage IB, the tumor is either:
not more than 1 millimeter thick, with ulceration, and may have spread into the dermis or the tissues below the skin; or
1 to 2 millimeters (more than 1/16 inch) thick, with no ulceration.

Stage II
Stage II is divided into stages IIA, IIB, and IIC.

Stage IIA: In stage IIA, the tumor is either:
1 to 2 millimeters thick, with ulceration; or
2 to 4 millimeters (a little more than 1/8 of an inch) thick, with no ulceration.
Stage IIB: In stage IIB, the tumor is either:
2 to 4 millimeters thick, with ulceration; or
more than 4 millimeters thick, with no ulceration.
Stage IIC: In stage IIC, the tumor is more than 4 millimeters thick, with ulceration.

Stage III
In stage III, the tumor may be of any thickness, with or without ulceration, and may have spread to 1 or more nearby lymph nodes. Stage III is divided into stages IIIA, IIIB, and IIIC.

Stage IIIA: In stage IIIA, the cancer may have spread to as many as 3 nearby lymph nodes, but can only be seen with a microscope.
Stage IIIB: In stage IIIB, the cancer either:
has spread to as many as 3 lymph nodes and may not be visible without a microscope; or
has satellite tumors (additional tumor growths within 1 inch of the original tumor) and has not spread to lymph nodes.
Stage IIIC: In stage IIIC, the cancer either:
has spread to as many as 4 or more lymph nodes and can be seen without a microscope; or
has lymph nodes that may not be moveable; or
has satellite tumors and may have spread to lymph nodes.

Stage IV
In stage IV, the tumor has spread to other organs or to lymph nodes far away from the original tumor.

Recurrent Melanoma
Recurrent melanoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the original site, or in other parts of the body, such as the lungs or liver.

Treatment Option Overview

There are different types of treatment for patients with melanoma. Different types of treatment are available for patients with melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Four types of standard treatment are used:

Surgery
Surgery to remove the tumor is the primary treatment of all stages of melanoma. The doctor may remove the tumor using the following operations:

Local excision: Taking out the melanoma and some of the normal tissue around it.
Wide local excision with or without removal of lymph nodes.

Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer.
Sentinel lymph node biopsy: A procedure used to see if cancer cells are present in the sentinel lymph node (the first lymph node where cancer cells are likely to have spread). The doctor injects a radioactive substance and/or blue dye near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes. The surgeon removes only nodes with the radioactive substance or dye. A pathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes. Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.

Even if the doctor removes all the melanoma that can be seen at the time of the operation, some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

In treating melanoma, chemotherapy drugs may be given as a hyperthermic isolated limb perfusion. This technique sends anticancer drugs directly to the arm or leg in which the cancer is located. The flow of blood to and from the limb is temporarily stopped with a tourniquet, and a warm solution containing anticancer drugs is put directly into the blood of the limb. This allows the patient to receive a high dose of drugs in the area where the cancer occurred.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found.

Biological therapy
Biological therapy is treatment to stimulate the ability of the immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Other types of treatment are being tested in clinical trials.

Chemoimmunotherapy
Chemoimmunotherapy is the use of anticancer drugs combined with biological therapy to boost the immune system to kill cancer cells.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options By Stage

Stage 0 Melanoma
Treatment of stage 0 melanoma is usually surgery to remove the tumor and a small amount of normal tissue around it.

Stage I Melanoma
Treatment of stage I melanoma may include the following:

1.Surgery to remove the tumor and some of the normal tissue around it.
2.A clinical trial of surgery to remove the tumor and some of the normal tissue around it, with or without lymph node mapping and selective lymphadenectomy.
3.A clinical trial of new techniques to detect cancer cells in the lymph nodes.
4.A clinical trial of lymphadenectomy with or without adjuvant therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage II Melanoma
Treatment of stage II melanoma may include the following:

1.Surgery to remove the tumor and some of the normal tissue around it, followed by removal of nearby lymph nodes.
2.Lymph node mapping and sentinel lymph node biopsy, followed by surgery to remove the tumor and some of the normal tissue around it. If cancer is found in the sentinel lymph node, a second surgical procedure can be performed to remove additional nearby lymph nodes.
3.Surgery followed by high-dose biological therapy.
4.A clinical trial of adjuvant chemotherapy and/or biological therapy, or immunotherapy.
5.A clinical trial of new techniques to detect cancer cells in the lymph nodes.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage III Melanoma
Treatment of stage III melanoma may include the following:

1.Surgery to remove the tumor and some of the normal tissue around it.
2.Surgery to remove the tumor with skin grafting to cover the wound caused by surgery.
3.Surgery followed by biological therapy.
4.A clinical trial of surgery followed by chemotherapy and/or biological therapy.
5.A clinical trial of biological therapy.
6.A clinical trial comparing surgery alone to surgery with biological therapy.
7.A clinical trial of chemoimmunotherapy or biological therapy.
8.A clinical trial of hyperthermic isolated limb perfusion using chemotherapy and biological therapy.
9.A clinical trial of biological therapy and radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IV Melanoma
Treatment of stage IV melanoma may include the following:

1.Surgery as palliative therapy to relieve symptoms and improve quality of life.
2.Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
3.Chemotherapy and/or biological response modifier (BRM) therapy.
4.A clinical trial of new chemotherapy and/or biological therapy, or vaccine therapy.
5.A clinical trial of radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
6.A clinical trial of surgery to remove all known cancer.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Melanoma
Treatment of recurrent melanoma may include the following:

1.Surgery to remove the tumor.
2.Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
3.Palliative treatment with biological therapy.
4.Hyperthermic isolated limb perfusion.
5.A clinical trial of biological therapy and/or chemotherapy as palliative therapy to relieve symptoms and improve quality of life.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.






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