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What is melanoma?

Melanoma is a type of skin cancer that develops in the skin cells called melanocytes and  usually occurs on the parts of the body that have been overexposed to the sun. Rare melanomas can occur inside the eye or in parts of the skin or body that have never been exposed to the sun such as the palms of the hands, the soles of the feet or under the nails.

Melanoma is projected to be the third most common cancer diagnosed in Australia in 2020, which along with New Zealand has the world's highest incidence rate for melanoma. Melanoma is more commonly diagnosed in men than women. The risk of being diagnosed with melanoma by age 85 is 1 in 13 for men compared to 1 in 21 for women. 

It is estimated that 16,221 new cases of melanoma will be diagnosed in Australia in 2020.



Melanoma symptoms

Often melanoma has no symptoms, however, the first sign is generally a change in an existing mole or the appearance of a new spot. These changes can include:

  • colour - a mole may change in colour, have different colour shades or become blotchy

  • size - a mole may appear to get bigger

  • shape - a mole may have an irregular shape, may increase in height or not be symmetrical

  • elevation - the mole may develop a raised area

  • itching or bleeding.

Other symptoms include dark areas under nails or on membranes lining the mouth, vagina or anus.

New moles and spots will appear and change during childhood, adolescence and during pregnancy and this is normal. However, adults who develop new spots or moles should have them examined by their doctor. 



Causes of melanoma

Melanoma risk increases with exposure to UV radiation from the sun or other sources such as solariums, particularly with episodes of sunburn (especially during childhood).

Melanoma risk is increased for people who have:

  • unprotected UV radiation exposure

  • a history of childhood tanning and sunburn

  • a pattern of short, intense periods of exposure to UV radiation

  • having a lot of moles (naevi) – more than 50 on the body and more than 10 above the elbows on the arms

  • increased numbers of unusual moles (dysplastic naevi)

  • depressed immune systems

  • a family history of melanoma in a first degree relative

  • fair skin, a tendency to burn rather than tan, freckles, light eye colour (blue or green), light or red hair colour

  • had a previous melanoma or non-melanoma skin cancer.



Diagnosis of melanoma

Melanoma can vary in the way it looks. The first sign is usually a new spot or change in an existing mole.

Physical examination

If you do notice any changes to your skin, your doctor will examine you and carefully check any spots you have identified as changed. Your doctor will use a handheld magnifying instrument (dermascope) and consider the criteria known as “ABCDE”. Further tests may be carried out by your GP or you may be referred to a specialist (dermatologist).

  • A - Asymmetry, irregular
  • B - Border (uneven or scalloped edges)
  • C – Colour (differing shades and colour patches)
  • D - Diameter (usually over 6mm)
  • E - Evolving (changing and growing).

Biopsy

If the doctor suspects that a spot on your skin could be melanoma, an excision biopsy is carried out with the removal of the whole spot. This will then be examined under a microscope by a specialist to see if there are any cancer cells.

Checking lymph nodes

Your doctor may feel the lymph nodes near the melanoma to see if they are enlarged as melanoma can sometimes travel via the lymph vessels to other parts of your body. Your doctor may also recommend a biopsy to take a sample of the cells from an enlarged lymph node for further examination under a microscope.

If the doctor suspects melanoma, a biopsy may be carried out. This may be done by your GP or you may be referred to another specialist.

After a diagnosis of melanoma  

After being diagnosed with melanoma, you may feel shocked, upset, anxious or confused. These are normal responses. A diagnosis of melanoma affects each person differently. For most it will be a difficult time, however some people manage to continue with their normal daily activities. 

You may find it helpful to talk about your treatment options with your doctors, family and friends. Ask questions and seek as much information as you feel you need. It is up to you as to how involved you want to be in making decisions about your treatment. 

Find out more about the best melanoma care:

  



Treatment for melanoma

Staging

Test results will show whether you have melanoma and if it has spread to other parts of the body. The melanoma will be given a statge of 0-4, usually written in Roman numerals. The most important feature of a melanoma in predicting its outcome is its thickness.

  • stage 0 is less than 0.1mm
  • stage I less than 2mm
  • stage II greater than 2mm
  • stage III spread to lymph nodes and stage IV spread to distant skin and/or other parts of the body.

The presence of ulceration also predicts a poor outcome. If distant spread is suspected, CT scans of the chest, abdomen and pelvis are performed. The blood test LDH can sometimes be useful to assess metastatic disease.

Early-stage melanoma

Surgery (wide local excision) can be curative for thin melanomas and requires that the melanoma be removed as well as more normal-looking skin around the melanoma (usually between 5mm and 10mm). 

Many people with early melanoma don’t need to have lymph nodes removed. However, in some cases, you may have a sentinel lymph node biopsy which removes the first lymph node the melanoma may have spread to.

The removal of the lymph nodes can cause side effects such as swelling in your neck, ark or neck.  This is called lymphoedema.

If there is a risk that the melanoma could come back, you may be offered additional treatments. These can include immunotherapy and targeted therapy.

Advanced melanoma

Treatment for advanced melanoma, where the cancer has spread to lymph nodes, internal organs or bones, may include surgery, radiation therapy targeted therapy or immunotherapy.

Surgery may be used to treat metastatic melanoma that involves other parts of the skin. Surgery may also still be possible if the melanoma has spread to other organs but will depend on the part of the body that is affected.

Radiation therapy may be of benefit in treating some forms of melanoma. It may be used:

  • when cancer has spread to the lymph nodes
  • after surgery to prevent the cancer returning
  • in combination with other treatments
  • as palliative treatment.

Targeted therapy drugs attack specific genetic changes (mutations) that allow melanomas to grow and spread while minimising harm to healthy cells. It is most commonly used for melanomas that have spread to other organs or if it has come back after treatment.

Immunotherapy uses drugs to stimulate the body's immune system in order to recognise and fight melanoma cancer cells. Ipilimumab, nivolumab and pembrolizumab are three immunotherapy drugs approved for treatment of advanced melanoma.

Palliative care

In some cases of melanoma cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of melanoma, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, or other drug therapies.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Dermatologist- specialises in preventing, diagnosing and treating skin diseases.
  • Reconstructive (plastic) surgeon- performs any complex reconstructive surgery that restores or repairs the body's appearance and function.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Physiotherapist/occupational therapist- help with physical and practical problems such as restoring movement and mobility after treatment.
  • Surgeon- Surgeon which can be a general surgeon, a surgical oncologist to manage complex skin cancers or a plastic surgeon trained in complex constructive techniques, including surgery if the cancer has spread..


Screening for melanoma

There is no organised screening program for melanoma. However, individuals at high risk of melanoma should be taught to check their skin for irregular or changing lesions, and have annual checks by a dermatologist.

Download Cancer Council's skin cancer identification poster to help identify potential skin cancers:



Preventing melanoma

Avoid sunburn by minimising sun exposure when the UV Index is 3 or above, and especially in the middle of the day when UV levels are most intense. Seek shade, wear a hat that covers the head, neck and ears, wear sun protective clothing and close-fitting sunglasses, and wear an SPF30 sunscreen. Avoid using solariums.

Work outdoors? Use UV protection every day - Download the PDF here:



Prognosis for melanoma

Prognosis refers to the predicted outcome of a disease. It is not possible for a doctor to predict the exact course of the disease. An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis.

Melanoma can be most effectively treated in its early stages when it is still confined to the top layer of the skin. 



Sources

Understanding Melanoma, Cancer Council Australia, © 2021. Last medical review of source booklet: January 2021. 

Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) books: Stomach cancer. Canberra: AIHW. 

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