Melanoma: Causes, Symptoms, Stages, and Treatment Options

What is Melanoma?

Melanoma is a type of skin cancer that begins in the melanocytes, which are the cells responsible for producing melanin—the pigment that gives skin its color. 

According to the American Cancer Society (ACS), melanoma makes up only about 1% of all skin cancers, but it accounts for the majority of skin cancer-related deaths. Unlike other skin cancers, melanoma is more aggressive because it can spread quickly to other parts of the body if not detected early. 

While other skin cancers often remain localized, melanoma can invade deeper tissues and reach vital organs. This ability to spread makes early detection crucial for effective treatment.

Types of Melanoma

• Superficial Spreading Melanoma: The most common type, accounting for about 70% of cases, typically appears as a flat or slightly raised discolored patch that spreads horizontally. It often arises from an existing mole and varies in color, from brown and black to red. This type is more common in younger individuals.
• Nodular Melanoma: The second most common and more aggressive type, nodular melanoma presents as a raised bump that can be black, blue-black, or red. It grows vertically into the skin, making it more dangerous if not detected early, and is more common in older adults, often appearing on the trunk, head, or neck.
• Lentigo Maligna Melanoma: Usually found in older adults with extensive sun exposure, this type begins as a flat or slightly raised tan or brown patch on sun-exposed areas like the face and arms. Over time, it can darken and expand.
• Acral Lentiginous Melanoma: The rarest type, it typically appears on the palms, soles, or under the nails, often resembling a bruise or dark streak. It is more common in people with darker skin and is challenging to detect.

Symptoms of Melanoma

Identifying melanoma early significantly improves the chances of successful treatment. The symptoms of melanoma often begin with changes to the skin that may be easy to overlook. Here are some early signs and what to look out for:

Early Signs

The American Academy of Dermatology (AAD) does highlight the ABCDE Rule as a simple and effective way to remember the warning signs of melanoma:

• A - Asymmetry: One half of the mole or spot does not match the other half.
• B - Border: The edges are irregular, ragged, notched, or blurred.
• C - Color: The color is not uniform and may include different shades of brown, black, tan, red, white, or blue.
• D - Diameter: The spot is larger than 6 millimeters across (about the size of a pencil eraser), although melanomas can be smaller.
• E - Evolving: The mole is changing in size, shape, or color over time.

These signs are critical for catching melanoma in its earliest stages. Even if a mole doesn't fit all these criteria, any changes or unusual appearances should prompt a visit to a healthcare professional.

Additional Symptoms

In addition to changes in moles, other symptoms might indicate melanoma:

• Pain or tenderness in a mole or surrounding skin
• Itching in or around a mole
• Bleeding or oozing from a mole
• Changes in texture, such as a mole becoming hard or lumpy
• Ulceration, where the surface of the mole breaks down, leading to a sore

If you notice any of these symptoms, it’s essential to seek medical advice immediately. Early detection can be life-saving.

Hidden Melanomas

Melanomas can also develop in less obvious areas of the body. These hidden melanomas might appear under the nails, on the soles of the feet, palms of the hands, or even in the eyes, nose, mouth, or throat. 

In people with darker skin tones, melanoma is more likely to occur in these less exposed areas. It’s important to regularly check these areas for any unusual changes or signs.

For a more detailed evaluation, using an online tool like Symptom Checker can help you track any concerning symptoms. However, always consult a healthcare professional for an accurate diagnosis and treatment plan.

Stages of Melanoma

The stage of melanoma at diagnosis determines how far the cancer has spread and what treatment options are most suitable. Here’s an overview of the stages:

• Stage 0 (Melanoma in situ): The melanoma is limited to the outer skin layer (epidermis) and hasn’t spread deeper. It is highly treatable with surgery, with a nearly 100% cure rate.
• Stage I: The melanoma is up to 2 millimeters thick, may or may not be ulcerated, and hasn’t spread to lymph nodes. Surgery is typically very effective, with a high survival rate.
• Stage II: The melanoma is thicker than 2 millimeters, possibly up to 4 millimeters, and has not spread to lymph nodes. While the risk of spreading increases, early treatment remains successful.
• Stage III: The melanoma has spread to nearby lymph nodes or skin but not to distant organs. Treatment is more complex, often involving surgery, immunotherapy, or radiation.
• Stage IV: The melanoma has spread to distant lymph nodes or organs like the lungs, liver, or brain. This advanced stage focuses on managing symptoms and improving quality of life through available treatments.

Understanding the stages of melanoma helps in making informed decisions about treatment options and outcomes.

Causes and Risk Factors

Understanding the causes and risk factors associated with melanoma is essential for effective prevention and early detection. Several factors contribute to the development of melanoma, with some being more controllable than others.

Genetic Factors

Genetic predispositions significantly influence the risk of developing melanoma. According to the AAD, around 10% of melanomas are caused by an inherited genetic mutation. A family history, particularly if a parent or sibling has had melanoma, increases this risk.

Conditions like familial atypical multiple mole melanoma (FAMMM) syndrome also elevate susceptibility.

Environmental Factors

Environmental factors, especially UV radiation from sunlight and tanning beds, are major contributors to melanoma. UV exposure damages the DNA in skin cells, leading to mutations that can cause melanoma. 

Intense, intermittent sun exposure, often resulting in sunburn, and the use of tanning beds, even minimally, is strongly linked to increased melanoma risk.

Other Risk Factors

Several additional factors can increase the risk of melanoma:

• Skin Type: According to ACS, having lighter skin color is a major risk factor for melanoma. Light skin contains less melanin, the pigment that provides some protection against UV radiation.
• Number of Moles: Having a large number of moles, particularly atypical or dysplastic moles, increases the risk of melanoma. These atypical moles are often larger, have irregular borders, and vary in color, making them more likely to become cancerous.
• Age: While melanoma can occur at any age, the risk increases with age. Older adults, particularly those with a history of significant sun exposure, are more likely to develop melanoma.
• History of Sunburns: Experiencing severe, blistering sunburns, especially during childhood or adolescence, increases the risk of melanoma later in life. Each sunburn damages the DNA in skin cells, increasing the likelihood of mutations that can lead to melanoma.

Prevention Tips

Reducing the risk of melanoma involves taking proactive steps to protect the skin from UV radiation and other risk factors:

• Use Sunscreen: Apply broad-spectrum sunscreen with an SPF of 30 or higher to all exposed skin, even on cloudy days. Reapply every two hours, especially after swimming or sweating.
• Wear Protective Clothing: Opt for long-sleeved shirts, wide-brimmed hats, and UV-blocking sunglasses. Clothing made from tightly woven fabrics offers better protection against the sun.
• Avoid Peak Sun Hours: Limit exposure to the sun during peak hours, typically between 10 a.m. and 4 p.m., when UV rays are strongest.
• Seek Shade: Stay in the shade whenever possible, especially during peak sun hours. This reduces direct exposure to harmful UV rays.
• Avoid Tanning Beds: Refrain from using tanning beds, as the UV radiation from these devices is harmful and significantly increases the risk of melanoma.

Diagnosis

Early detection of melanoma greatly improves the chances of successful treatment. A combination of self-examination and professional diagnosis can help identify melanoma in its early stages.

Self-Examination Techniques

Regular self-examination is a vital tool in detecting melanoma early. When conducting a skin check, it's important to be thorough and consistent. 

Begin by examining the entire body, including less obvious areas like the soles of the feet, under the nails, and the scalp. 

Look for any new spots, changes in existing moles, or unusual growths. The ABCDE Rule can be particularly helpful in identifying suspicious moles.

Professional Diagnosis

When a suspicious mole or spot is identified, professional medical evaluation is necessary. This process typically involves a physical examination, biopsy procedures, and possibly imaging tests.

• Physical Examination: A healthcare provider will examine the skin, paying close attention to the size, shape, color, and texture of the mole or spot. They may also ask about personal and family medical history to assess risk factors.
• Biopsy Procedures: If a mole or spot appears suspicious, a biopsy will be performed to determine whether it is cancerous.
  • Punch Biopsy: A circular blade is used to remove a small core of tissue from the suspicious area for examination.
  • Excisional Biopsy: The entire mole or spot, along with a margin of surrounding skin, is removed for analysis. This method is often used if melanoma is strongly suspected.
  • Sentinel Lymph Node Biopsy: This procedure is used to determine if melanoma has spread to nearby lymph nodes. A dye is injected near the tumor site, and the first lymph node that absorbs the dye (the sentinel node) is removed and examined for cancer cells.
• Imaging Tests: If there is a concern that melanoma may have spread beyond the skin, imaging tests may be used to examine the body internally.
  • CT Scans: Provide detailed images of internal organs to detect cancer spread.
  • PET Scans: Help identify areas of high metabolic activity, which may indicate cancer spread to other parts of the body.
  • MRI Scans: Used to examine soft tissues, including the brain and spinal cord, for signs of melanoma.

Detecting melanoma early is critical because it significantly improves treatment outcomes. When melanoma is identified and treated in its early stages, the chances of a full recovery are much higher. Regular self-examinations, along with professional evaluations, can lead to early detection and a better prognosis.

Treatment Options

The treatment of melanoma varies depending on the stage of the disease and the overall health of the individual. Various treatment options are available, each tailored to the specific needs of the patient.

• Surgery: The primary treatment for melanoma, especially in early stages. It involves removing the tumor and some surrounding healthy tissue. In more advanced cases, lymph nodes may also be removed.
• Radiation Therapy: Uses high-energy rays to target and destroy cancer cells, often used when melanoma has spread to lymph nodes or as a palliative treatment in advanced stages.
• Immunotherapy: Boosts the immune system to fight cancer cells. It is often used for melanoma that has spread or cannot be fully removed by surgery.
• Targeted Therapy: Involves drugs that target specific genetic mutations in melanoma cells, blocking their growth and spread.
• Chemotherapy: Uses powerful drugs to kill rapidly dividing cancer cells. It’s less commonly used for melanoma but may be an option if other treatments are ineffective.
• Emerging Treatments: New treatments, including advanced immunotherapies and targeted therapies, are being tested in clinical trials to improve outcomes.

Treatment by Stage

• Stages 0-I: Surgery is typically sufficient.
• Stage II: Surgery plus close monitoring.
• Stage III: Combination of surgery, immunotherapy, and radiation.
• Stage IV: Focuses on managing symptoms, often involving multiple treatment approaches.