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Everything You Need To Know About Melanoma

Arming yourself with knowledge about this type of skin cancer can help you spot the signs and take action to help protect your health.

Melanoma is a serious form of skin cancer. People who spend a lot of time in the sun, have lighter skin tones, or have many moles are at an increased risk of developing the condition.

Protect yourself from sun exposure, check for any changes to moles, and follow up with your doctor if you notice anything unusual. Prompt diagnosis and treatment can improve the outlook for this form of skin cancer.

Here's everything you need to know about melanoma.

Melanoma is a specific kind of skin cancer. It begins in skin cells called melanocytes. Melanocytes produce melanin, the substance that gives your skin color.

Only about 1% of skin cancers are melanomas. Melanoma is also called malignant melanoma or cutaneous melanoma.

When people receive a melanoma diagnosis in the early stages, they mostly respond well to treatment. But when not caught early, it spreads easily to other parts of the body.

Types of melanoma

There are six main types of melanoma:

  • Superficial spreading melanoma: This is the most common type of melanoma. It tends to spread across the surface of the skin, has uneven borders, and varies in color from brown to black, blue, or pink.
  • Nodular melanoma: This type of melanoma grows down into deeper layers of the skin and may appear as a raised bump or dark brown or black growth.
  • Acral-lentiginous melanoma: This is more common in darker skin tones. It looks like a large, uneven, dark patch on the surface of the skin, typically on the palms of the hand, soles of the feet, or nail beds.
  • Lentigo maligna melanoma: This type tends to appear on parts of the body that get more sun, especially the face. It looks like a large, uneven, dark patch on the surface of the skin.
  • Amelanotic melanoma: This type can be difficult to spot, as it involves an absence of color, but it can also cause changes in mole sizing, borders, and symmetry.
  • Desmoplastic melanoma: This rare type of melanoma typically affects the head and neck, making it more difficult to diagnose.
  • There are also other, more rare types of melanoma. While melanoma most commonly affects the skin, some less common types affect internal tissues and the eyes.

    Melanoma may also be known as metastatic melanoma when the cancer metastasizes (spreads) to other parts of the body, possibly including the lymph nodes, organs, or bones.

    Where can melanoma show up on my body?

    Melanoma can appear anywhere on the skin.

    In lighter skin tones, melanoma is more likely to start on the chest and back for men or the legs for women. The neck and face are also common places.

    In darker skin tones, melanoma is more likely to develop in other areas.

    Here's what melanoma may look like on different parts of the body:

    Early signs and symptoms of melanoma are:

  • changes to an existing mole
  • the development of a new, unusual growth on your skin
  • If melanoma cells are still making melanin, the tumors tend to be brown or black. Some melanomas don't make melanin, so those tumors can be tan, pink, or white.

    Clues that a mole might be melanoma are:

  • irregular shape
  • irregular border
  • multicolored or uneven coloring
  • larger than a quarter of an inch
  • changes in size, shape, color, or surface
  • itchiness, oozing, or bleeding
  • Melanoma can start anywhere on your skin but are most likely to develop on the:

  • chest and back for men
  • legs for women
  • neck
  • face
  • This may be because these areas have more exposure to the sun than other parts of the body. Melanoma can form in areas that don't receive much sun, such as the soles of your feet, palms of your hands, and fingernail beds.

    Sometimes, the skin will appear as usual even though melanoma has begun to develop.

    It's not entirely clear what causes melanoma.

    Typically, healthy new skin cells nudge older skin cells toward the surface, where they die. However, DNA damage within the melanocytes can cause new skin cells to grow out of control. As the skin cells build up, they form a tumor.

    We don't know exactly why DNA in skin cells becomes damaged. But a combination of factors may come into play and increase your risk of developing melanoma, such as:

  • UV light: Exposure to UV radiation is a leading risk factor. UV radiation can come from natural sunlight, tanning beds, and tanning lamps.
  • Race: Melanoma is more common in people with lighter skin tones and facial features. However, keep in mind that this data may be due to inequities in healthcare and other contributing factors.
  • Moles: Besides skin with less pigment, having many moles may also be a risk factor.
  • Genetics/family history: If a parent or sibling has had melanoma in the past, you may have a higher chance of developing melanoma.
  • Age: Anyone can develop melanoma, but the risk of melanoma increases as you age. The average age at diagnosis is 65 years, even though it's also one of the most common cancers among young adults.
  • Biological sex: Generally speaking, men are more likely to develop melanoma than women. However, before 50 years old, women are at a higher risk. After age 50, men are at a higher risk.
  • A weakened immune system: People who have certain health conditions or have undergone treatments that affect the immune system are more likely to develop melanoma.
  • Previous history of skin cancer: If you've received a melanoma diagnosis or another type of skin cancer in the past, that increases your risk of getting it again.
  • Cancer staging tells you how far the cancer has grown from its origin. Cancer can spread to other parts of the body through tissue, the lymph system, and the bloodstream.

    Doctors stage melanoma as follows:

    Stage 0

    You have abnormal melanocytes, but only on the outermost layer of skin (epidermis). This is also called melanoma in situ.

    Stage 1

    Stage 1 melanoma has two distinct categories:

  • 1A: The tumor is less than 1 millimeter (mm) thick and may be with or without ulceration.
  • 1B: The tumor is between 1 mm to 2 mm thick with no ulceration.
  • Stage 2

    There are three distinct categories for stage 2 melanoma:

  • 2A: The tumor is between 1 mm and 2 mm thick with ulceration. Or, it's between 2 mm and 4 mm thick without ulceration.
  • 2B: The tumor is between 2 mm and 4 mm and is ulcerated. Or it's thicker than 4 mm without ulceration.
  • 2C: The tumor is over 4 mm thick and is ulcerated.
  • Stage 3

    You have a tumor of any size that may or may not be ulcerated. At least one of these is also true:

  • tests have found cancer in at least one lymph node
  • lymph nodes are joined together
  • cancer is in a lymph vessel between the tumor and the closest lymph nodes
  • there are cancer cells more than 2 centimeters (cm) from the primary tumor
  • doctors discovered other tiny tumors on or under your skin within 2 cm of the primary tumor
  • Stage 4

    Cancer has spread to distant sites, such as the:

  • lungs
  • liver
  • brain
  • spinal cord
  • muscle and other soft tissue
  • digestive tract
  • distant lymph nodes
  • Stage 4 melanoma is also known as metastatic melanoma.

    Doctors use a variety of exams and tests to help confirm a melanoma diagnosis.

    Physical examination

    First, you'll need a thorough examination of your skin. As adults, most of us have between 10 and 40 moles.

    A regular mole usually has a uniform color and a clear border. They can be round or oval, and are generally less than a quarter of an inch in diameter.

    A thorough skin examination will involve looking in less obvious places, such as:

  • between the buttocks
  • genitals
  • palms and under your fingernails
  • scalp
  • soles of your feet, between your toes, and under your toenails
  • Blood chemistry studies

    Your doctor can check your blood for lactate dehydrogenase (LDH). When you have melanoma, levels of this enzyme can be higher than usual.

    A doctor may not check LDH levels in early stage disease.

    Skin biopsy

    A skin biopsy is the only way to confirm melanoma. A biopsy involves removing a sample of the skin and, if possible, the entire suspected area. Then, the tissue is sent to a lab for examination under a microscope.

    Your doctor will receive the pathology report and explain the results.

    If you receive a melanoma diagnosis, it's important to determine the stage. This will provide information on your overall outlook and help guide treatment.

    The first part of staging is to find out how thick the tumor is. This can involve measuring the melanoma under a microscope.

    Lymph node biopsy

    If you have a diagnosis, your doctor may need to find out if cancer cells have spread, though they won't do this for melanoma in situ. The first step is to perform a sentinel node biopsy.

    This surgery will involve injecting into the area where the tumor was. This dye will naturally flow to the nearest lymph nodes, which the surgeon will remove to test for cancer.

    If the test doesn't find cancer in the sentinel nodes, it probably hasn't spread outside the original area under investigation. If the biopsy does detect cancer, a doctor may test the next set of nodes.

    Imaging tests

    Imaging tests help determine whether cancer has spread beyond the skin to other parts of the body.

  • Ultrasound: This test uses sound waves and echoes to create imagery of the lymph nodes near the tumor.
  • CT scan: A medical professional will inject a dye into your vein before the scan, which takes a series of X-rays at different angles. The dye helps highlight organs and tissues.
  • MRI: For this test, a medical professional will inject a substance called gadolinium into a vein. The scanner uses magnet and radio waves to take pictures, and the gadolinium causes cancer cells to brighten.
  • PET scan: This test requires injecting a small amount of radioactive glucose into a vein. Then, the scanner will rotate around your body. Cancer cells use more glucose and will show up on the screen.
  • What tests stage melanoma?

    Your doctor may review the results from all of your tests — from a physical exam to a biopsy, blood test, and imaging results — to help determine the stage of melanoma.

  • the depth of the original melanoma tumor
  • other pathological features
  • whether the cancer has spread to nearby lymph nodes or beyond
  • Surgical removal, known as excision, is the primary treatment for all stages of melanoma, particularly localized melanoma. Doctors will also remove a margin of healthy tissue to ensure no cancer cells are left behind.

    A complete excision along with a lymph node biopsy (or elective lymph node removal) is considered standard treatment for primary melanoma.

    More advanced stages of melanoma may involve additional treatment after surgery with:

  • immunotherapy
  • targeted therapy
  • radiation
  • chemotherapy
  • vaccine therapy
  • Each type of therapy comes with its own set of side effects, some of which can be serious. It's important to discuss these with your doctor so you can make an informed choice.

    However, exact treatment recommendations vary based on the stage of melanoma.

    Stage 0

    Treatment for stage 0 melanoma involves surgical removal of the suspicious tissue. It's usually possible to completely remove the entire area during the biopsy for diagnosis. If not, your surgeon can remove it afterward, along with a border of regular skin.

    You may not need further treatment.

    Stage 1

    Treatment for stage 1 melanoma involves surgical removal of the cancer along with a margin of healthy skin and a layer of tissue underneath the skin. It may also include lymph node biopsy or removal.

    Stage 1 melanoma typically doesn't usually require additional treatment.

    Stage 2

    This type of melanoma is treated by removing the tumor, along with a margin of healthy skin and a layer of tissue below. The procedure may also include lymph node biopsy or removal.

    If there's a high risk of recurrence, you may receive immunotherapy after surgical removal.

    Stages 3 and 4

    Stage 3 melanoma has spread away from the primary tumor or into nearby lymph nodes. An excision procedure removes the tumor and any affected lymph nodes. You may also have a skin graft to cover the surgical wound.

    If there is a high risk of recurrence, a doctor may follow up this procedure with immunotherapy or targeted therapy. You may also receive radiation or vaccine therapy.

    In stage 4 melanoma, cancer has spread to distant parts of the body. Your surgical options depend on the number, size, and location of tumors.

    Treatment for stage 3 melanoma that surgery cannot remove, stage 4 melanoma, and recurrent melanoma may also include:

  • immunotherapy
  • targeted therapy
  • radiation
  • chemotherapy
  • vaccine therapy
  • palliative therapy
  • Clinical trials can help you get innovative therapies not yet approved for general use. If you're interested in joining a clinical trial, talk with your doctor.

    It's natural to want to research survival rates, but it's important to understand that they're generalizations. Your circumstances are unique, so it's advisable to speak with your doctor about your own outlook.

  • 100% for localized melanoma
  • 74.8% for regional spread
  • 35% for distant metastasis
  • Doctors diagnose approximately 83% of melanoma cases at the local stage.

    When it comes to your individual outlook, survival rates are only rough estimates. Your doctor can offer you a more individualized assessment.

    Some factors that can affect your outlook are:

  • Age: Older people tend to have shorter survival times.
  • General health: Treatment may be less effective if you have a weakened immune system or other underlying health problems.
  • As you can see from the relative survival rates above, many people survive melanoma. Later-stage melanoma is more challenging to treat, but it's possible to survive many years after diagnosis.

    Every year in the United States, 21.2 out of every 100,000 people receive a diagnosis of melanoma. The sooner you receive a diagnosis and treatment, the better your outlook.

    While you can't completely eliminate your risk, certain strategies can help prevent melanoma and other skin cancers from developing:

  • Avoid the midday sun whenever possible: The strongest UV rays are between 10 a.M. And 4 p.M. If you go outside during these hours, try to stay in the shade. Remember that the sun still affects your skin on cloudy days and throughout winter.
  • Use sunscreen: Use a broad-spectrum sunscreen with an SPF of at least 30. Reapply every 2 hours or more often if you sweat a lot or go in the water. Do this regardless of the season.
  • Cover up: When spending time outdoors, keep your arms and legs covered. Wear a broad-brimmed hat to protect your head, ears, and face. Wear sunglasses that protect from UVA and UVB rays.
  • Minimize unnecessary UV exposure: Avoid indoor tanning beds or tanning lamps to reduce your risk.
  • Following a healthy lifestyle — for example, eating a nutrient-rich diet, limiting alcohol intake, and exercising regularly — may also help minimize your risk of melanoma.

    Above all else, checking your skin regularly and reporting any unusual moles or suspicious skin changes to your doctor can help you address it quickly.

    Check your body regularly for new growths
  • Note size, shape, and color changes to existing moles, freckles, and birthmarks.
  • Remember to check the bottoms of your feet, between your toes, and nail beds.
  • Use a mirror to check hard-to-see areas such as your genitals and between your buttocks.
  • Take photos to make it easier to spot changes.
  • Report any suspicious findings to your doctor right away.

  • Uveal Melanoma: Causes, Symptoms, And Treatment Options

    Uveal melanoma is a type of cancer that develops in the middle layer of your eye called the uvea. It can cause symptoms like blurry vision, floaters, or loss of vision.

    Melanoma is a type of cancer that grows in cells called melanocytes that give your skin and tissues their pigment.

    Uveal melanoma develops in the melanocytes in your eye's uvea. The uvea is a layer of tissue that consists of the:

  • ciliary body, a ring of muscle that changes the shape of your vision lens
  • choroid, which contains blood vessels
  • iris, the colored part of your eye
  • The outlook for uveal melanoma is often best when the cancer starts in your iris. This is because tumors in this location are often identified and treated early.

    Uveal melanoma that is diagnosed before it spreads to other tissues and body parts responds well to treatment. However, the outlook tends to worsen if the cancer spreads to your liver or other organs.

    Eye melanoma is an extremely rare cancer, but it's the most common type of primary eye cancer in adults. Primary eye cancer means it starts in your eye instead of spreading from other tissues to the eye.

    Eye melanoma develops in about 1 in 200,000 adults. It's much less common than skin melanoma, which is the fifth most common cancer in the United States for men and women.

    Melanoma that starts in your uvea is called uveal melanoma. Uveal melanoma starts in the choroid in about 90% of cases. The other 10% of cases start in your iris or ciliary body.

    Eye melanoma can also start in the thin, clear layer that covers your eye white, called the conjunctiva. Melanoma that starts here is called conjunctival melanoma.

    About 30% of people with uveal melanoma don't have any symptoms in the early stages. When symptoms do appear, they often include:

  • blurry vision
  • double vision
  • distorted vision
  • some level of vision loss
  • seeing flashing lights
  • eye irritation or pain
  • feeling like something is in your eye
  • eye redness
  • bulging eye
  • change in pupil shape (the pupil is the opening in the center of the iris)
  • increased pressure in the eye
  • The signs and symptoms you develop can depend on the size of the melanoma tumor and where it's located. For example, people with melanoma on the iris may develop a growing dark spot.

    It's important to see an eye doctor any time you notice changes in your vision. The doctor may order many tests to determine the cause of your symptoms. If they suspect cancer, you may go through diagnostics tests such as:

    Like most cancers, the exact cause of uveal melanoma isn't fully understood, but a combination of factors likely plays a role. Identified risk factors of uveal melanoma include:

  • light-colored eyes and fair skin
  • dysplastic nevus syndrome (atypical mole syndrome)
  • atypical or common cutaneous nevi (unusual moles or eye freckles)
  • family history of BAP1 cancer predisposition syndrome
  • age (most cases are diagnosed in people ages 60 and older)
  • It's not clear if ultraviolet (UV) light exposure increases the risk of uveal melanoma. If it does, its role is thought to be less significant than for skin melanoma.

    According to research, about 98% of cases of uveal melanoma develop in Caucasian people. Eye melanoma is diagnosed in Caucasians around 8 to 10 times more often than in people of African descent.

    No cure has been found for cancer. However, doctors consider cancer cured if you go into complete remission for 5 years. Remission means that you no longer have symptoms of the disease.

    Many people who receive treatment for uveal melanoma achieve complete remission, especially if their cancer has not spread to other tissues.

  • conservative management, meaning the cancer is closely monitored without delivering any particular treatment
  • radiation therapy
  • laser therapies such as:
  • transpupillary thermotherapy
  • laser photocoagulation
  • surgery, which might involve removing the tumor or the eye
  • immunotherapy drugs like tebentafusp-tebn or darovasertib for people with metastatic cancer
  • Can you prevent uveal melanoma?

    Many of the risk factors of uveal melanoma, like family history, cannot be managed or prevented.

    It's not clear if UV light exposure is linked to an increased risk of uveal melanoma, but it's still a good idea to UV protection for your eyes when out in the sun to support your overall eye health.

    Uveal melanoma has the best outlook when it's diagnosed and treated before it spreads.

    Doctors often use 5-year relative survival rates for reporting cancer survival. This statistic is a measure of how many people with a certain cancer are alive 5 years after receiving their diagnoses compared to people without that cancer.

    The 5-year relative survival rates for eye melanoma in the United States from 2012 to 2018 were as follows:

    As many as 50% of people with eye melanoma experience spread to distant organs. This is called metastatic melanoma.

    About 80% of metastatic eye melanomas spread to the liver, which typically worsens the outlook. Other areas it can spread to include your:

  • lungs
  • skin
  • soft tissues
  • bone
  • The spread to these locations can occur 2 to 3 years after the initial diagnosis or as late as decades after.

    The outlook for uvea melanoma is usually best when the tumor develops in your iris. Melanoma in the iris rarely spreads to other body parts because it's usually detected earlier.


    Proteomic Profiling Reveals Ferroptosis Sensitivity In Melanoma

    The following is a summary of "Unbiased Drug Target Prediction Reveals Sensitivity to Ferroptosis Inducers, HDAC and RTK Inhibitors in Melanoma Subtypes," published in the December 2024 issue of Dermatology by Pla et al. 

    The use of PD1 and CTLA4 inhibitors has transformed malignant melanoma (MM) treatment, but resistance to targeted and immune-checkpoint therapies remains a significant challenge.  

    Researchers conducted a retrospective study to mine large-scale MM proteogenomic data to identify druggable targets and predict treatment efficacy and resistance.  

    They analyzed protein profiles from established MM subtypes and the molecular structures of 82 cancer treatment drugs to identify 9 candidate hub proteins: mTOR, FYN, PIK3CB, EGFR, MAPK3, MAP4K1, MAP2K1, SRC, and AKT1, which spanned 5 MM subtypes. These proteins were considered potential drug targets for 1 or more MM subtypes. Additionally, they integrated proteogenomic profiles from MM subtypes with MM cell line dependency and drug sensitivity data, identifying 162 potentially targetable genes. Finally, 20 compounds were found to have potential drug impact in at least 1 MM subtype.  

    The results showed that employing unbiased approaches revealed compounds targeting ferroptosis, exhibiting a remarkable 30-fold difference in sensitivity across different MM subtypes.  

    Investigators concluded that proteomic profiling of melanoma samples suggests innovative and novel therapeutic strategies through stratification of patients, offering a spectrum of novel therapeutic interventions and the potential for combination therapies. 

    Source: onlinelibrary.Wiley.Com/doi/full/10.1111/ijd.17586 






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