Frequently Asked Questions about Melanoma

This information was provided by the American Cancer Society, Inc. (http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?rnav=criov&dt=39) Last Medical Review: 07/01/2008

Q: What is melanoma skin cancer?
A: Melanoma is a cancer that begins in the melanocytes. Because most of these cells still make melanin, melanoma tumors are often brown or black. But this is not always the case, and melanomas can also have no color. Melanoma most often starts on the trunk of fair-skinned men and on the lower legs of fair-skinned women, but it can start in other places, too. Having dark skin lowers the risk of melanoma. But it does not mean that a person with dark skin will never get melanoma.

Melanoma can almost always be cured in its early stages. But it is likely to spread to other parts of the body if it is not caught early. Melanoma is much less common than basal cell and squamous cell skin cancers, but it is far more serious.

Q: Who gets melanoma skin cancer?
A: Skin cancer is the most common of all cancers. Melanoma accounts for less than 5% of skin cancer cases. But it causes most skin cancer deaths. The number of new cases of melanoma in the United States has not changed much in the last 8 years. Overall, the lifetime risk of getting melanoma is about 1 in 50 for whites, 1 in 1,000 for blacks, 1 in 200 for Hispanics.

Q: What are the risk factors of melanoma?
A: The following are risk factors associated with Melanoma:
UV (ultraviolet) light, Moles, Fair Skin, Family history of melanoma, Past history of melanoma, Weakened immune systems, Age, Gender, Xeroderma pigmentosum (XP)

Q: What can a woman do to decrease her risk of getting melanoma cancer?
A: Most skin cancer can be prevented especially by preventative measures such as:

  • Limit UV exposure
  • Protect your skin with clothing
  • Wear a hat
  • Use sunscreen & wear sunglasses
  • Stay in the shade
  • Protect children
  • Avoid other sources of UV light
  • Check for abnormal moles and have them removed
  • Genetic counseling and testing

Q: What are the symptoms of melanoma cancer?
A: The ABCD rule can help you tell a normal mole from an abnormal mole. Moles that have any of these signs should be checked by your doctor. ABCD stands for the following:

  • Asymmetry: One half of the mole does not match the other half.
  • Border irregularity: The edges of the mole are irregular or not smooth. They may look ragged, blurred, or notched.
  • Color: The color over the mole is not the same all over. There may be shades of tan, brown, or black, and sometimes patches of pink, red, blue, or white.
  • Diameter: The mole is larger than about ¼ inch-- about the size of a pencil eraser-- although sometimes melanomas can be smaller

Q: What is the staging of melanoma?
A: Staging is the process of finding out how widespread the cancer is. This includes finding out how big it is and whether it has spread to the lymph nodes or any other organs. The tests described above are used to help decide the stage of the melanoma. Staging is very important because the treatment and the outlook (prognosis) for your recovery depend on the stage of the cancer.
Stages are labeled using 0 and the Roman numerals I through IV (1-4). In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer.

There are really 2 types of staging for melanoma. The clinical stage is based on what is found in the physical exam, biopsy, x-rays, CT scans, and so on. The pathological stage uses all of this information plus what is found during biopsies of lymph nodes or other organs. So the clinical stage (which is done first) may be lower than the pathologic stage, which is found after the biopsy.
After looking at your test results, the doctor will tell you the stage of your cancer. Be sure to ask your doctor to explain your stage in a way you understand. This will help you both decide on the best treatment for you.

Q: How does the thickness of melanoma matter?
A: The thickness of the melanoma as seen in the skin biopsy is called the "T category." The thinner the melanoma, the better the outlook. For the most part, melanomas less than about 1/25 of an inch deep (about the size of a period or a comma) have a very small chance of spreading. Thicker melanomas have a greater chance of spreading. The thickness of the melanoma also guides the choice of treatment.

In one method of measuring the thickness of the melanoma, the doctor uses a device something like a small ruler. This is called the Breslow measurement. Another system describes the thickness of a melanoma in relation to layers of the skin instead of actually measuring it. The Clark level of a melanoma uses a scale of I to V (1-5) to describe which layers of the skin are involved. Higher numbers mean a deeper melanoma.

Most often, the Breslow measurement of thickness is used in staging the cancer. Sometimes, though, the Clark level shows that a melanoma is more advanced than it appears from the Breslow measurement. Because of this, both systems may be used to describe a melanoma.
In either system, the melanoma is said to have a worse prognosis if it is ulcerated; this means that there is no covering layer of skin.

Q: What are clinical trials?
A: Clinical trials are carefully controlled research studies that are done with patients. These studies test whether a new treatment is safe and how well it works. Clinical trials may also test new ways to find or prevent a disease. These studies have led to many new ways to prevent, diagnose, and treat cancer. Clinical trials are done to get a closer look at new treatments or procedures. A clinical trial is only done when there is good reason to believe that the treatment, test, or procedure being studied may be better than the one used now. Treatments used in clinical trials are often found to have real benefits. If that happens, they may go on to become tomorrow's standard treatment.

Q: What's New in Melanoma Research?

  • Concerning sunlight and radiation, recent studies suggest there may be 2 ways that UV rays causes melanoma. The first way is linked to a lot of sun exposure and sunburns as a child or teenager. This early sun exposure starts a change in skin cells that may later turn into melanoma. Some doctors think this accounts for melanomas that start on the legs and trunk -- areas that aren't often exposed to the sun in adulthood.
  • The second link is to melanomas that start on the arms, neck, and face. These areas are often exposed to sun, particularly in men. Tanning booths may also help these kinds of melanomas develop.
  • Most skin cancer can be prevented. You can do this by avoiding too much sun exposure and protecting yourself and your children when you are in the sun. Don't forget that sunscreen should be used to protect skin from the sun's rays during normal activity. It should not be used to allow you to spend more time in the sun.
  • Scientists have made a lot of progress during the past few years in learning how UV light harms DNA. Changes in DNA can cause normal skin cells to become cancer. People who have a strong family history of melanoma should talk to a cancer genetic counselor or a doctor who knows about cancer genetics to discuss the benefits and possible drawbacks to genetic testing.
  • Advances in research are also being applied to staging the cancer. Very sensitive new tests can better find the spread of melanoma to lymph nodes. One type of test can find one melanoma cell among a million normal cells. This might help identify some patients who could be helped with treatments like immunotherapy after surgery. New ways of working with the immune system to fight cancer are being studied. Researchers are working on vaccines aimed at making a person immune to his or her melanoma cells. Another method is to train a person's immune cells to attack the melanoma cells.
  • One of the most promising new ideas in treating melanoma involves adding certain genes to the cancer cells. There are different ways that adding these genes can help to fight the cancer. Clinical trials testing gene therapy are going on now.

Q: How Can I Learn More?
A: You can learn more about Melanoma Cancer by contacting any of the following:

This information was provided by the American Cancer Society, Inc. (http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?rnav=criov&dt=39) Last Medical Review: 07/01/2008