Melanoma

Melanoma is a type of skin cancer that starts in melanocytes, the skin cells responsible for producing pigment. It most commonly occurs in areas that have been overexposed to the sun, like your arms, legs, or face. In rare cases, melanoma can also develop in less obvious places, such as the palms of your hands, soles of your feet, under your nails, or even inside the eye (ocular melanoma).

While melanoma is less common than other types of skin cancer, it is considered the most serious because it can spread to other parts of the body – especially if not detected early. The sooner melanoma is found, the better the chances for successful treatment.

Australia and New Zealand have the highest melanoma rates globally, and more than 4180 people in Queensland are diagnosed each year.

Melanoma is the second most common cancer for both men and women.

The major sub-types of melanoma are:

This type of melanoma makes up 55–60% of all cases. While most common in people under 40, it can occur at any age. It can start as a new brown or black spot that grows on the surface of the skin, or an existing spot, freckle or mole that changes size, colour or shape. It can develop on any part of the body but especially the trunk. It often grows slowly and becomes more dangerous when it invades the lower layer of the skin.

This type makes up about 10–15% of melanomas and is most commonly found in people over 65. It appears as a round, raised lump (nodule) on the surface of the skin that is pink, red, brown or black and feels firm to touch. It may develop a crusty surface that bleeds easily. Most commonly found on the head and neck, it is fast-growing and can spread quickly into the lower layer of the skin.

This type makes up about 10–15% of diagnoses. Most common in people over 40, it begins as a large coloured spot (lentigo maligna) in an area of sun-damaged skin, such as the face, ears, neck and head. It may grow slowly and superficially over many years before becoming more invasive.

A rare type of melanoma (about 1–2% of all cases), it mostly affects people over 40 and is commonly found on the palms of the hands, soles of the feet, or under the fingernails or toenails. It generally starts as a colourless or lightly coloured area that can be mistaken for a stain, bruise or unusual wart. In the nails it can look like a long streak of pigment. It tends to grow slowly before becoming invasive.

Another rare type of melanoma (about 1–2% of cases), it usually affects people over 60 and appears on the head and neck of sun-damaged skin. Desmoplastic melanoma starts as a firm, fast-growing, skin-coloured lump, sometimes described as scar-like. Some have a patch of overlaying pigmentation and can be difficult to diagnose.

Some rarer types of melanoma start in parts of the body other than the skin. Mucosal melanoma can start in the tissues in the mouth, anus, urethra, vagina or nasal passages. Ocular melanoma can start inside the eye. Melanoma can also start in the central nervous system

Melanoma is primarily caused by overexposure to UV radiation from the sun or artificial sources like tanning beds, which are now banned for commercial use in Australia due to their significant health risks.

UV exposure can damage skin cells, and this damage accumulates over time, increasing the likelihood of skin cancer.

Certain factors heighten the risk of melanoma, including:

• Unprotected exposure to UV radiation
• A history of childhood tanning and sunburn
• A pattern of short, intense periods of exposure to UV radiation
• Having lots of moles (more than 50 on the body or 10 above the elbows)
• Unusual, irregularly shaped moles
• Pale, fair or freckled skin, especially if it burns easily and doesn’t tan
• Light coloured eyes (blue or green), and fair or red hair
• A family history of melanoma
• A weakened immune system
• A previous melanoma or non-melanoma skin cancer

How a melanoma looks can vary greatly, and there are often no noticeable symptoms to begin with. The earliest sign is typically a change in an existing mole or the appearance of a new spot. Changes to watch for include:

• Size – The mole or spot may grow larger.
• Colour – It may become blotchy or develop multiple shades (brown, black, red, white, grey, pink, or skin-toned).
• Shape – The mole may develop an irregular edge, increase in height, or lack symmetry (the halves look different).
• Elevation – A mole may become raised or develop a reddish or brownish raised area.
• Itching or bleeding – The mole may itch or bleed occasionally.

New moles often appear during childhood, adolescence, and pregnancy, which is normal. However, adults of any age can have new and changing spots, so it is important to self-examine your skin regularly, so you get to know what is normal for you.

Fully undress in good lighting and use mirrors to examine your whole body, including hard-to-see areas.

See your doctor if you notice a mole, freckle, or lump that is new or changing in size, shape, or colour, or if you have a sore that hasn’t healed within 4–6 weeks.

If you notice suspicious-looking changes on your skin you should check-in with your doctor immediately. They will carefully examine your skin, checking any spots you’re concerned about, and may ask if you or your family have a history of melanoma.

While assessing your skin, they may use a handheld magnifier called a dermascope and follow the ABCDEFG guide:

• A – Asymmetry: Are the halves of the spot uneven?
• B – Border: Are the edges irregular, scalloped, or notched?
• C – Colour: Are there multiple shades or colour patches?
• D – Diameter: Is the spot larger than 6mm, or is it growing?
• E – Elevated: Is it raised?
• F – Firm: Does it feel firm to touch?
• G – Growing: Is it increasing in size quickly?

If melanoma is suspected, your doctor may perform an excision biopsy, removing the entire spot to examine it under a microscope. This can usually be done in your GP’s office or by a specialist.

Your doctor might also check nearby lymph nodes to see if they are enlarged, as melanoma can spread through the lymphatic system. If needed, a biopsy of the lymph nodes may be done.

Melanoma treatment can vary depending on the stage and whether it has spread. Early stage melanoma (stages (0–2) can generally be treated successfully with surgery alone. This involves removing the melanoma along with some surrounding healthy skin, a procedure called wide local excision.

If the melanoma has spread to nearby lymph nodes (stage III), removing lymph nodes and additional (adjuvant) treatments may be needed. To remove the lymph nodes, a procedure called lymphadenectomy will be performed under general anaesthetic. If there is a risk the melanoma might return after surgery, other treatments such as immunotherapy, targeted therapy or radiation therapy may also be recommended.

Advanced melanoma (stage IV) is where the cancer has spread to other parts of the body such as lymph nodes, internal organs or bones. Treatment options include surgery, radiation therapy, targeted therapy or immunotherapy.

In some cases your treatment team may talk to you about palliative care, which aims to improve your quality of life by alleviating symptoms or cancer. This may include radiotherapy or other drug therapies. Gain a deeper understanding of different tests.

When we talk about prognosis, we’re talking about the likely or expected outcome of the disease, although it’s important to remember that not even an expert can predict the exact way your melanoma will progress.

Early stage melanoma, when it’s confined to the top layer of the skin (epidermis), responds best to treatment. If it spreads deeper into the skin or beyond to lymph nodes or other organs, treatment becomes more complex.

Thanks to advances in research and clinical trials, new treatments are continually improving outcomes for people with advanced melanoma.

It’s normal to feel worried about your prognosis and the future. Talking with loved ones or seeking support from Cancer Council Queensland 13 11 20 can provide comfort and practical advice.