Melanoma is a type of skin cancer that results when cancerous cells start to grow in melanocytes, or cells that produce melanin. These are the cells responsible for giving the skin its color. Melanoma can occur anywhere on the skin, even in the eyes. Although the condition is rare, doctors are diagnosing a larger number of people with melanoma than ever before.
If a person has been diagnosed with melanoma, a doctor will conduct tests to determine how much the melanoma has spread and how large the tumor is. A doctor will then use this information to assign a stage to the cancer type. There are five main stages of melanoma, from stage 0 to stage 4. The higher the number, the more advanced the cancer tends to be.
By using the staging process, doctors and patients are better able to understand their treatment options and prognosis. Staging provides a quick reference point to help doctors communicate with one another regarding a person’s treatment plan and overall outlook.
CLINICAL STAGE I AND II
Melanoma has the potential to metastasize to any organ; common sites of dissemination include the skin, subcutaneous tissues, lymph nodes, lungs, liver, bone, brain, and visceral organs.
However, there is no role for routine imaging studies beyond sentinel lymph node mapping and biopsy in asymptomatic patients with clinical stages I and II disease (table 1A-B), as the identification of metastatic disease in this setting is negligible:
- Lymphatic mapping and sentinel lymph node biopsy – The indications for lymphatic mapping and sentinel lymph node biopsy in patients with clinical stage I and II disease are discussed separately. (See “Evaluation and treatment of regional lymph nodes in melanoma”.)
Preventing and detecting second skin cancers
Routine screening with a skin examination for a new melanoma and non-melanoma skin cancer is a necessary part of follow-up care, as is sun protection and sun avoidance. Screening for melanoma and other skin cancers may include mole mapping (photography of the moles) by a doctor or other health care professional. If possible, you should ask your doctor for copies of your photographs and learn how to perform a skin self-examination. There is growing evidence that individuals who are followed using photographs are diagnosed at an earlier stage of melanoma.
Protecting your skin from UV radiation is important to help prevent second skin cancers, either melanoma or non-melanoma skin cancer. Many people who are treated for melanoma lead an active, outdoor lifestyle. It is important to take steps to protect yourself from further skin damage. You can protect against further sun damage by:
- Participating in outdoor activities before 10:00 AM or after 4:00 PM
- Wearing long sleeves and pants
- Using a broad-spectrum sunscreen with an SPF of at least 30. Please remember to reapply sunscreen every 2 hours or, if you are sweating or in the water, every hour.
- Wearing UV-protective sunglasses
- Wearing a hat
A major consideration following diagnosis and treatment of melanoma is adjusting a person’s lifestyle to use sun-protective or sun-avoidance measures at all times, as well as avoiding indoor tanning devices. In addition, if a person works in an area where there is high UV exposure, there may be job-related issues to consider. Learn more about protecting your skin from the sun.
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 find and diagnose melanoma:
Skin exam: A doctor or nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
Biopsy : A procedure to remove the abnormal tissue and a small amount of normal tissue around it. A pathologist looks at the tissue under a microscope to check for cancer cells. It can be hard to tell the difference between a colored mole and an early melanoma lesion. Patients may want to have the sample of tissue checked by a second pathologist. If the abnormal mole or lesion is cancer, the sample of tissue may also be tested for certain gene changes.
It is important that abnormal areas of the skin not be shaved off or cauterized (destroyed with a hot instrument, an electric current, or a caustic substance) because cancer cells that remain may grow and spread.
See the PDQ summary on Skin Cancer Screening for more information.
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