Melanoma is a serious, aggressive form of skin cancer that develops in the melanocytes—the cells responsible for producing melanin, the pigment that gives your skin its colour. This cellular change is often the result of damage, most commonly caused by exposure to the sun's ultraviolet (UV) radiation.
While melanoma accounts for approximately 3% of all skin cancer cases, it is responsible for the majority of skin cancer deaths and has a higher likelihood of spreading (metastasising) to other parts of the body if not caught early. It is also one of the more frequently occurring cancers in young adults aged 20 to 30 and is the primary cause of cancer death in women between 25 and 30 years old.
The initial sign of melanoma is usually:
For fair-skinned men, melanoma is most commonly found on the trunk, and for fair-skinned women, it is typically on the lower legs. In darker-skinned individuals, it most often appears on the palms of the hands, the soles of the feet, and beneath the nails. When detected and treated early, melanoma is often curable.
Melanoma is generally classified into three main types:
This is the most common form of melanoma, with four major subtypes:
This is a rare type, comprising about 1% of melanoma cases. It develops in the mucosal tissue that lines body cavities and hollow organs. Common sites include the head and neck region (nasal cavity, mouth, and oesophagus), rectum, urinary tract, and vagina. It is often very difficult to detect, and even with diagnosis and treatment, the prognosis can often be poor.
As melanocytes are present in the eyes, they can also be susceptible to melanoma. The two main types are Uveal Melanoma and Conjunctival Melanoma.
A risk factor is anything that increases the likelihood of developing melanoma. While not everyone with risk factors will develop the cancer, it is advisable to discuss them with your healthcare provider.
The primary risk factor is sun damage, particularly a history of peeling sunburns. Exposure to artificial sunlight from tanning beds carries the same risk as natural sunlight.
Other risk factors for melanoma include:
Individuals with light skin, blond or red hair, and blue eyes who tend to sunburn easily are at increased risk.
A personal history of melanoma.
Having a large number of benign (non-cancerous) moles.
Having a close family member who has had melanoma.
This condition, previously known as dysplastic nevus syndrome, is characterised by having a large number of atypical moles. Regular screening is recommended for you and your family members if you have AMS.
In addition to managing these risk factors, behavioural and lifestyle changes can help prevent melanoma. If you have an elevated risk, please review the appropriate screening guidelines and consider genetic counselling, as some cases of melanoma can be inherited.
The signs and symptoms of melanoma can vary between patients. A helpful and easy way to remember the early warning signs of melanoma skin cancer is using the ABCDEFs guide:
One half of the mole or spot does not match the other half.
The edges are ragged, blurred, or irregular.
The colour is uneven, or the spot contains multiple colours, such as shades of brown, black, red, white, or blue.
The lesion is larger than the diameter of a pencil eraser (about 6 millimetres).
The mole or spot is changing in size, shape, or height.
There is a change in sensation, such as itching, tenderness, or pain around the mole or spot.
Important: It is crucial to show any suspicious area of skin, non-healing sore, or any new or changing mole or freckle to a medical doctor immediately.
An early and accurate diagnosis is vital for effective melanoma skin cancer treatment, as it helps determine the extent of spread and informs your doctor's choice of therapy.
SSCHRC employs advanced, accurate technology and highly skilled staff, including pathologists and diagnostic radiologists, to diagnose melanoma and detect any spread, thereby increasing the likelihood of successful treatment.
If you present with signs or symptoms of melanoma, your doctor will conduct a physical examination and ask about your health, lifestyle, and family history. If a spot is suspected to be melanoma, a biopsy will be performed.
Melanoma skin cancer cannot be diagnosed by visual examination alone. If a pigmented area changes or appears abnormal, your doctor will take a tissue sample for microscopic examination by a pathologist. It is important that suspicious areas are not simply removed by shaving or cauterisation before a biopsy confirms if the area is malignant (cancerous).
Common biopsy methods include:
The pathologist will examine the sample for cancer cells. Abnormal results may indicate melanoma, as well as other conditions like benign growths (moles, warts), squamous cell carcinoma, or basal cell carcinoma. Given that melanoma can be challenging to diagnose, a second pathology review of your biopsy is often recommended.
Once melanoma is confirmed, further tests may be advised to determine if cancer cells have spread within the skin or to other parts of the body. These may include:
Imaging Tests: Such as Chest X-ray, Lymphoscintigraphy, Ultrasound, CT (Computed Axial Tomography) scans, MRI (Magnetic Resonance Imaging) scans, and PET (Positron Emission Tomography) scans.
Staging classifies the extent of the disease and is essential for determining the most effective treatment plan and predicting the outlook for recovery (prognosis). Melanoma staging is based on:
Stages I and II are primarily based on the thickness and microscopic features of the primary tumour. Stages III and IV are based on how far the melanoma has spread from the skin, with Stage III indicating regional spread and Stage IV indicating distant spread.
Abnormal melanocytes are found only in the epidermis (the top layer of skin).
Cancer has formed and is divided into Stages IA (tumour ≤1 mm thick) and IB (tumour >1 mm to ≤2 mm thick, without ulceration).
Divided into Stages IIA, IIB, and IIC, based on tumour thickness and presence of ulceration.
Cancer has spread regionally and is divided into Stages IIIA, IIIB, IIIC, and IIID, based on factors including primary tumour, affected lymph nodes, and presence of microsatellite/satellite/in-transit metastases.
The cancer has spread to distant parts of the body (e.g., lungs, liver, brain, bone, digestive tract, or distant lymph nodes) or to distant skin areas.
Upon diagnosis of melanoma skin cancer, your doctor will discuss the best treatment options. At SSCHRC, your treatment plan will be carefully customised to your specific needs. One or more of the following therapies may be recommended to treat the cancer or manage symptoms:
The surgical approach depends on the thickness of the melanoma tumour and whether it has spread.
Cancer radiation therapy uses high-energy beams to destroy cancer cells and may be used as part of your treatment plan, sometimes combined with chemotherapy.
These innovative treatments are designed to target the specific genetic and molecular alterations within melanoma tumour cells. Treatment may include:
Immunotherapy is an advanced treatment that harnesses the body's natural immune system to fight the cancer. It is generally used for advanced melanoma that has spread to distant parts of the body. Treatment options may include:
In some cases, chemotherapy may be combined with Interleukin 2, Interferon, or T-cell therapy.
SSCHRC offers the most modern and effective chemotherapy options, which may be used to treat the cancer.
Patients who have had melanoma have an increased risk of developing new melanomas or experiencing a recurrence (the cancer returning) in nearby skin or other parts of the body. To ensure early detection of any new or recurrent melanoma, you must adhere to your doctor's schedule for regular check-ups. For patients at high risk of recurrence, follow-up care may include X-rays, blood tests, and imaging scans of the chest, liver, bones, and brain. Regular checks for melanoma are also advised for your family members.