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Table of Contents General Information About Melanoma
Stages of Melanoma
Recurrent Melanoma
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Recurrent Melanoma
To Learn More About Melanoma
Get More Information From NCI
Changes to This Summary (10/17/2008)
About PDQ
General Information About Melanoma
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Melanoma is a disease in which malignant (cancer) cells form in
the skin cells called melanocytes (cells that color the skin).
Melanocytes are found
throughout the lower part of the epidermis. They make melanin, the pigment that gives skin its natural
color. When skin is exposed to the sun, melanocytes make more pigment,
causing the skin to tan, or darken. | Enlarge | | | | Anatomy of the skin, showing the epidermis, dermis, and subcutaneous tissue. Melanocytes are in the layer of basal cells at the deepest part of the epidermis. |
The skin is the body’s largest organ. It protects against heat,
sunlight, injury, and infection. The
skin has 2 main layers: the epidermis (upper or outer layer) and the dermis (lower or inner layer).
When melanoma starts in
the skin, the disease is called cutaneous melanoma. This PDQ summary is about
cutaneous (skin) melanoma. Melanoma may also occur in the eye and is called intraocular or ocular melanoma. (See the PDQ summary on Intraocular (Eye) Melanoma
Treatment for more information.)
There are 3 types of skin cancer:
Melanoma is more aggressive than basal cell skin cancer or squamous
cell skin cancer. (See the PDQ summary on Skin Cancer Treatment for more information on basal cell and squamous cell skin cancer.)
Melanoma can occur anywhere on the body.
In men,
melanoma is often found on the trunk (the area from the shoulders to the hips)
or the head and neck. In women, melanoma often develops on the arms and legs.
Melanoma usually occurs in adults, but it is sometimes found in children and
adolescents.
Unusual moles, exposure to sunlight, and health history can
affect the risk of developing melanoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for melanoma include the
following:
- Unusual moles.
- Exposure to natural sunlight.
- Exposure to artificial ultraviolet light (tanning
booth).
- Family or personal history of melanoma.
- Being white and older than 20 years.
- Red or blond hair.
- White or light-colored skin and freckles.
- Blue eyes.
Possible signs of melanoma include a change in the appearance
of a mole or pigmented area.
These and other symptoms may be caused by melanoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems
occur:
- A mole that:
- changes in size, shape, or color.
- has irregular edges or borders.
- is more than 1 color.
- is asymmetrical (if the mole is divided in half, the 2
halves are different in size or shape).
- itches.
- oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the underlying tissue shows through).
- Change in pigmented (colored) skin.
- Satellite moles (new moles that grow near an existing
mole).
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 detect and diagnose melanoma:
- Skin examination: A doctor or nurse examines the skin to look
for moles, birthmarks, or other pigmented areas that look abnormal in color,
size, shape, or texture.
- Biopsy: A local excision is done to remove as
much of the suspicious mole or lesion as possible. A pathologist then looks at the
tissue under a microscope to check
for cancer cells. Because melanoma can be hard to diagnose, patients should consider having their biopsy sample checked by a second pathologist.
Suspicious areas should not be shaved off or cauterized (destroyed with a hot
instrument, an electrical current, or a caustic substance).
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on
the following:
- The stage of melanoma (whether cancer is
found in the outer layer of skin only, or has spread to the lymph nodes, or to other places in the body.
- Whether there was bleeding or ulceration at the primary site.
- The location and size
of the tumor.
- The patient’s
general health.
Although many people are successfully treated, melanoma can recur (come back).
Back to Top Stages of Melanoma
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After melanoma has been diagnosed, tests are done to find out
if cancer cells have spread within the skin or to other parts of the body.
The process used to find out whether cancer has spread within the skin or to other parts
of the body is called staging. The
information gathered from the staging process determines the stage of the
disease. It is important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging
process:
- Wide local excision: A surgical procedure to remove some of
the normal tissue surrounding the area where melanoma was found, to check for cancer cells.
- Lymph node
mapping and sentinel lymph node
biopsy: Procedures in which a radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes (the first lymph node or nodes where cancer
cells are likely to have spread). The surgeon removes only the nodes
with the radioactive substance or dye. A pathologist then checks the sentinel lymph nodes
for cancer cells. If no cancer cells are detected, it may not be necessary to
remove additional nodes.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma,
pictures may be taken of the chest, abdomen, and pelvis.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- PET scan (positron
emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
The results of these tests are viewed together with the results of
the tumor biopsy to determine the melanoma stage.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The Clark levels are used for thin tumors to describe how deep the cancer has spread into the skin:
Level I
The cancer is in the epidermis only.
Level II
The cancer has begun to spread into the papillary dermis (upper layer of the dermis).
Level III
The cancer has spread through the papillary dermis (upper layer of the dermis) but not into the reticular dermis (lower layer of the dermis).
Level IV
The cancer has spread into the reticular dermis (lower layer of the dermis).
Level V
The cancer has spread into the subcutaneous layer (below the skin).
The following stages are used for melanoma:
Stage 0 (Melanoma in Situ)
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| Stage 0 melanoma. Abnormal melanocytes are in the epidermis (outer layer of the skin). |
In stage 0, abnormal melanocytes are found in the epidermis (Clark level I).
These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.
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| Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm. |
Stage I
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| Stage I melanoma. In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration (break in the skin). In stage IB, the tumor is either not more than 1 millimeter thick, with ulceration, OR more than 1 but not more than 2 millimeters thick, with no ulceration. Skin thickness is different on different parts of the body. |
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
- Stage IA: In stage IA, the tumor is not more than 1 millimeter thick, with no ulceration.
The tumor is in the epidermis and the papillary dermis (Clark level II or III).
- Stage IB: In stage IB, the tumor is either:
- not more than 1 millimeter thick and it has ulceration or it has spread through the dermis or into the subcutaneous layer (Clark level IV or V) ; or
- more than 1 but not more than 2 millimeters thick, with
no ulceration.
Stage II
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| Stage II melanoma. In stage IIA, the tumor is either more than 1 but not more than 2 millimeters thick, with ulceration (break in the skin), OR it is more than 2 but not more than 4 millimeters thick, with no ulceration. In stage IIB, the tumor is either more than 2 but not more than 4 millimeters thick, with ulceration, OR it is more than 4 millimeters thick, with no ulceration. In stage IIC, the tumor is more than 4 millimeters thick, with ulceration. Skin thickness is different on different parts of the body. |
Stage II is divided
into stages IIA, IIB, and IIC.
Stage III
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| Stage III melanoma. The tumor may be any thickness with or without ulceration. It has spread either (a) into a nearby lymph vessel and may have spread to nearby lymph nodes; OR (b) to 1 or more lymph nodes, which may be matted (not moveable). Skin thickness is different on different parts of the body. |
In stage III, the tumor may be any thickness, with or without ulceration, and either:
- has spread into a nearby lymph vessel and may have spread into nearby lymph nodes; or
- has spread to 1 or more lymph nodes, which may be matted (not moveable).
Stage IV
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| Stage IV melanoma. The tumor has spread to other parts of the body. |
In stage IV, the cancer has spread to other places in the body.
Back to Top Recurrent Melanoma
Recurrent melanoma is cancer that has recurred
(come back) after it has been treated. The cancer may come back in the original
site or in other parts of the body, such as the lungs or liver.
Back to Top Treatment Option Overview
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There are different types of treatment for patients with
melanoma.
Different types of treatment are available for patients with melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
Surgery to remove the tumor is the primary treatment of
all stages of melanoma. The doctor
may remove the tumor using the following operations:
- Local excision:
Taking out the melanoma and some of the normal tissue around it.
- Wide local excision with or without removal of lymph nodes.
- Lymphadenectomy:
A surgical procedure in which the lymph nodes are removed and examined to see
whether they contain cancer.
- Sentinel lymph node
biopsy: The removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
| Enlarge | | | | Sentinel lymph node biopsy of the skin. A radioactive substance and/or blue dye is injected near the tumor (first panel), the injected material is detected visually and/or with a probe (middle panel), and the sentinel nodes (the first lymph nodes to take up the material) are removed and checked for cancer cells (last panel). |
Skin grafting (taking
skin from another part of the body to replace the skin that is removed) may be
done to cover the wound caused by surgery.
Even if the doctor removes all the melanoma that can be seen at
the time of the operation, some patients may be offered chemotherapy after surgery to kill
any cancer cells that are left. Chemotherapy given after surgery, to increase
the chances of a cure, is called adjuvant therapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
In treating melanoma, anticancer drugs may be given as a hyperthermic isolated limb perfusion. This
technique sends anticancer drugs directly to the arm or leg in which the cancer
is located. The flow of blood to and from the limb is temporarily stopped with
a tourniquet, and a warm solution containing anticancer drugs is put directly
into the blood of the limb. This allows the patient to receive a high dose of
drugs in the area where the cancer occurred.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Biologic therapy
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site
Chemoimmunotherapy
Chemoimmunotherapy is the use of anticancer drugs combined with
biologic therapy to boost the immune system to kill cancer cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Back to Top Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stage 0 (Melanoma in Situ)
Treatment of stage 0 is usually surgery to remove the area of abnormal cells and a small amount of normal tissue around it.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage I Melanoma
Treatment of stage I
melanoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage II Melanoma
Treatment of stage II melanoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage III Melanoma
Treatment of stage III melanoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IV Melanoma
Treatment of stage IV melanoma may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top Treatment Options for Recurrent Melanoma
Treatment of recurrent melanoma may include the
following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Back to Top To Learn More About Melanoma
For more information from the National Cancer Institute about melanoma, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (10/17/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match information in the health professional version and images were added.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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