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Melanoma

Overview

Melanoma is a type of skin cancer, the other main types being basal cell carcinoma and squamous cell carcinoma. Melanoma is the most aggressive of the skin cancers.

Melanoma is a cancer of skin cells called melanocytes, which produce the pigment in moles, freckles and tanned skin. Melanomas can occur anywhere on the skin, but are most common on the chest and back in men, and the legs in women. The head and neck are other common sites.

When melanoma starts in the skin, the disease is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips). When melanoma occurs in the eye, it is called intraocular or ocular melanoma

Risk Factors

Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma. Having a fair complexion, such as fair skin that freckles and burns easily, does not tan, or tans poorly; blue or green or other light-colored eyes or having red or blond hair can create an increased risk to developing Melanoma.

Although being white or having a fair complexion increases the risk of melanoma, anyone can develop melanoma, including people with dark skin.

Additionally, being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time can increase the risk.

Steps that can be taken to lower the risk of melanoma include reducing sun exposure (especially in the middle hours of the day), avoiding sunburn, avoiding artificial tanning, looking for new moles or signs of changes in existing moles, and having regular skin checks by a doctor.

Symptoms

Warning signs of possible melanoma include a mole that has one or more of the following features:

• is asymmetrical in shape
• has uneven, notched, or blurred edges
• has different colours or shades
• has grown in size
• has a hard or lumpy texture
• is oozing or bleeding.

Melanoma is not usually painful, although the affected skin may feel different e.g. itchy.

Diagnosis

Melanoma is diagnosed by taking a biopsy of the affected area of skin (lesion) and examining it in the laboratory. Other tests, including imaging, may be done find out the stage of the cancer and whether it has spread to other parts of the body.

Treatment

The primary treatment for melanoma is surgery, which involves removing the entire melanoma as well as at least 1 to 2 cm of normal skin around it. If the draining lymph nodes are found to be involved, they are removed too.

If the melanoma is found at an early stage and has not yet spread, surgical excision may be the only treatment required. For more advanced cases, treatment commonly includes a combination of surgery, radiation therapy and chemotherapy. Biological therapies designed to stimulate the immune system (such as interferon or interleukin 2) may also be given.

A vaccine for melanoma has been developed and is currently being tested in clinical trials, as are targeted therapies. Targeted therapies are drugs designed to target specific gene changes that make melanoma cells different to normal cells. For example, about half of all melanomas are found to have mutations in a gene called the BRAF gene. These mutations lead to a protein being produced that causes melanoma cells to grow and divide quickly. Drugs have therefore been developed that target this protein and inhibit its action.

Stages

Melanoma stages are based mainly on the thickness of the tumour and whether cancer has spread to the lymph nodes or to other parts of the body.

• Stage 0 – Melanoma in Situ
In stage 0, abnormal melanocyte cells are found in the epidermis – the outer layer of the two main layers of the skin. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.

• Stage I
Stage I melanoma is broken into two stages: stage IA and IB.
In stage IA, the tumour is smaller than 1mm in thickness and does not have any visible ulceration (break in the skin).
In stage IB, the tumour can either be smaller than 1mm thick with ulceration, or between 1 and 2mm thick with no ulceration.

• Stage II
Stage II melanoma is broken into three sub-stages: IIA, IIB and IIC.
In stage IIA, the tumour is either between 1 and 2mm thick with ulceration, or it is between 2 and 4mm thick with no ulceration.
In stage IIB, the tumour is between 2 and 4mm thick with ulceration, or it is more than 4mm thick, with no ulceration.
In stage IIC, the tumour is more than 4mm thick with ulceration.

• Stage III
Stage III melanoma is when the tumour may be of any thickness, with or without ulceration and has one of three additions.

1. The cancer has spread to one or more lymph nodes.
2. Lymph nodes with cancer may be joined together (known as “matted”).
3. The cancer may be in a lymph vessel between the primary tumour and nearby lymph nodes and/or very small tumours may be found on or under the skin, no more than 2cm away from the primary tumour.

• Stage IV
In stage IV, the cancer has metastasised meaning that it has spread to other places in the body. The most common parts of the body for skin cancer to spread include the lung, liver, brain, bone, soft tissue, or gastrointestinal (GI) tract.

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