Melanoma

Melanoma is a serious form of skin cancer that develops from melanocytes, the cells that produce pigment. It is less common than basal cell and squamous cell skin cancers but more likely to grow and spread if not treated early. Melanoma can appear on any skin surface, including areas not exposed to the sun, and can also arise in the eyes or mucous membranes.

Ultraviolet (UV) exposure from the sun and tanning beds is the major modifiable risk factor. Early detection through skin awareness and prompt biopsy of suspicious lesions is critical — thin melanomas have excellent cure rates with surgery alone, while advanced melanoma may require immunotherapy, targeted therapy, or other systemic treatments.

The ABCDE rule helps identify suspicious moles:

• Asymmetry — one half unlike the other
• Border irregularity — scalloped or poorly defined edges
• Color variation — multiple shades of brown, black, red, white, or blue
• Diameter — often larger than 6 mm (pencil eraser), though melanomas can be smaller
• Evolving — changing in size, shape, color, or symptoms (itching, bleeding)

Also watch for the “ugly duckling” — a mole that looks different from the person’s other moles. Nodular melanomas may grow vertically and appear as a new bump. Acral melanomas occur on palms, soles, or under nails and may be missed. Any new, changing, or unusual skin lesion deserves evaluation.

Melanoma results from genetic damage to melanocytes, most often from UV radiation. Cumulative and intermittent intense sun exposure (including sunburns) and indoor tanning increase risk. Inherited genetic variants (including CDKN2A and others) contribute in some families. Melanoma can also arise without obvious UV association, particularly acral and mucosal subtypes.

Risk factors include:

• Fair skin, freckling, light hair and eye color
• History of sunburns, especially blistering burns in childhood or adolescence
• Indoor tanning
• Many moles or atypical (dysplastic) nevi
• Personal or family history of melanoma
• Weakened immune system
• Older age (though melanoma is also one of the more common cancers in young adults)
• Xeroderma pigmentosum and certain other genetic conditions

If not caught early, melanoma can spread to lymph nodes and distant organs (lungs, liver, brain, bone). Advanced melanoma can be life-threatening. Treatment can cause side effects, including immune-related adverse events from checkpoint inhibitors and other toxicities from targeted or systemic therapies. Survivors need ongoing skin surveillance because of elevated risk of additional melanomas and other skin cancers.

Prevention and early detection strategies:

• Seek shade, especially midday
• Wear protective clothing, broad-brimmed hats, and UV-blocking sunglasses
• Use broad-spectrum sunscreen (SPF 30 or higher) and reapply regularly
• Avoid indoor tanning entirely
• Perform regular skin self-exams and report changes
• Obtain professional skin exams as recommended based on risk
• Protect children from sunburns

Diagnosis requires biopsy (preferably complete excision of the lesion when feasible) and pathologic examination. Breslow thickness, ulceration, mitotic rate, and other features determine staging. Further staging may include:

• Lymph node evaluation (sentinel lymph node biopsy for appropriate intermediate-thickness and thicker melanomas)
• Imaging (CT, PET-CT, MRI) when deeper or node-positive disease is present or symptoms suggest metastasis
• Molecular testing for BRAF and other mutations to guide targeted therapy when systemic treatment is needed

See a dermatologist or clinician promptly for any mole or skin lesion that is new, changing, asymmetric, irregularly bordered, multicolored, symptomatic, or different from your other moles. People at high risk benefit from regular full-skin examinations.

Treatment depends on stage:

• Thin, localized melanoma — wide local excision; sentinel node biopsy when indicated
• Node-positive or higher-risk disease — surgery plus consideration of adjuvant immunotherapy or targeted therapy
• Advanced / metastatic melanoma — immune checkpoint inhibitors (anti-PD-1, anti-CTLA-4, combinations), BRAF/MEK inhibitors for BRAF-mutant disease, clinical trials, and in selected cases radiation, surgery for oligometastases, or other systemic agents
• Management of brain metastases may include surgery, stereotactic radiosurgery, and systemic therapy

A multidisciplinary melanoma team provides optimal care for higher-stage disease.

After diagnosis:

• Follow surgical wound-care instructions
• Attend all follow-up and surveillance visits
• Continue rigorous sun protection
• Perform regular self-skin exams, including scalp, soles, and nails
• Report new or changing lesions promptly
• Discuss side effects of systemic therapy early with the oncology team
• Seek support for the emotional impact of a cancer diagnosis

Bring:

• History of when the lesion was first noticed and how it has changed
• Personal and family history of skin cancer
• Sun exposure and tanning history
• List of medicines
• Questions about biopsy results, staging, treatment options, and surveillance schedule