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Melanoma and other skin cancers - Melanoma

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of melanoma and nonmelanoma skin cancers.

Alternative Names

Skin cancer; Squamous cell cancer; Basal cell cancer; Actinic keratosis; Nonmelanoma skin cancer

Melanoma:

Melanoma accounts for only 5% of all skin cancers, yet it results in most of the skin cancer deaths, according to the American Cancer Society. About 62,720 new cases of melanoma will be diagnosed in the United States during 2009.

At first, melanoma cells are found in the epidermis and top layers of the dermis. However, once they grow downward into the dermis, the cancer can come into contact with lymph and blood vessels. The thicker the melanoma, the greater the likelihood that it could spread to distant sites.

Removing the lesion before it reaches the deeper layers of the skin is important to achieve a cure.

Specific Melanomas

Superficial Spreading Melanoma. Superficial spreading melanoma is the most common and most curable type of melanoma. It is flat, asymmetrical, unevenly colored, and usually grows outward across the surface of the skin. Superficial spreading melanoma accounts for about 70% of melanomas. In men, it occurs most often on the back. In women, it is most likely to be seen on the back of the leg.

Nodular Melanoma. Nodular melanoma appears as a fast-growing brown or black lump, and its characteristics do not always fit the definitions described above. It is important to check for this type of melanoma because it is associated with an outbreak of other tumors. Nodular melanoma accounts for about 5% of melanomas. It is usually seen on the trunk or limbs.

Lentigo Maligna. Lentigo maligna (sometimes called Hutchinson's freckle) usually occurs in elderly people and is marked by flat, mottled, tan-to-brown freckle-like spots with irregular borders. These lesions often appear on the face or other sun-exposed areas and typically grow slowly for 5 - 15 years before cancer appears. Lentigo maligna accounts for 4 - 15% of melano press mass.

Acral Lentiginous Melanoma. Although rare, acral lentiginous melanoma is the most common melanoma among African and Asian populations. It commonly appears as a dark patch on the palms, soles, fingers, or toes, under fingernails or toenails, or in mucus membranes.

Several unusual types of melanomas exist, but they are relatively uncommon.

Growth Pattern

Melanoma cells usually spread first through the lymph vessels or glands. Melanoma cells can also spread by way of blood vessels to various organs, carrying cancer to the liver, lungs, brain, or other sites.

Melanomas tend to grow in stages:

Most melanomas tend to be flat at first, and spread across the skin surface as they grow. At this early stage, which can last 1 - 5 years or longer, removing the growth has an excellent chance of curing the melanoma. Still, there is a possibility that some of these melanomas are invasive, and they should be treated aggressively.
Lesions that become raised or dome-shaped over at least part of their surface indicate that downward growth has occurred. In some cases, this growth is very rapid, occurring over a period of weeks to months.

Have any suspicious lesion checked immediately, especially if it has grown quickly or is partially flat and partially raised.

Location

Common sites of melanoma in men include:

Head
Middle of the body (trunk)
Neck

Common sites of melanoma in women include:

Arms
Legs

However, melanoma can affect any area of the skin. You may not notice melanomas if they appear on areas that are difficult to examine, such as the scalp or back.

Less common sites for melanoma include:

Fingers
Genitals
Lips
Palms
Soles of the feet
Under the fingernails or toenails

A dark lesion under the nail that runs into the nearby skin and doesn't heal may be a sign of melanoma.

Rarely, melanomas appear in the mouth, iris of the eye, or retina at the back of the eye, where they may be found during dental or eye examinations. While quite rare, melanoma can also develop in the mucus membranes, such as the vagina, esophagus, anus, urogenital tract, and small intestines.

Click the icon to see an image of melanoma.

Resources

www.aad.org -- American Academy of Dermatology
www.cancer.org -- American Cancer Society
www.asds.net -- American Society for Dermatologic Surgery
www.mpip.org -- Melanoma Patients' Information Page
www.cancer.gov -- National Cancer Institute
www.nccn.org -- National Comprehensive Cancer Network
www.skincancer.org -- The Skin Cancer Foundation
www.epa.gov/sunwise/uvindex.html -- UV index information

References

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American Cancer Society. Cancer Facts and Figures 2008. Atlanta, GA: American Cancer Society; 2008.

Anderson L, Schmieder GJ, Werschler WP, et al. Randomized, double-blind, double-dummy, vehicle-controlled study of ingenol mebutate gel 0.025% and 0.05% for actinic keratosis. J Am Acad Dermatol. 2009;60(6):934-43.

Basal cell and squamous cell cancers: NCCN Medical Practice Guidelines and Oncology;V.1.2009. Accessed July 15, 2009.

Braathen LR, Szeimies RM, Basset-Seguin N, Bissonnette R, Foley P, Pariser D, et al. Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus. International Society for Photodynamic Therapy In Dermatology, 2005. J Am Acad Dermatol. 2005;56:125-143.

Brantsch KD, Meisner C, Schonfisch B, Trilling B, Wehner-Caroli J, Rocken M, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. The Lancet Oncology. 2008;9:713-720.

Clinical practice guideline for melanoma: NCCN Medical Practice Guidelines and Oncology;V.2.2009. Accessed July 15, 2009.

Cyr PR. Atypical Moles. Am Fam Physician. 2008;78(6):735-40. Review.

deBerker D, McGregor JM, Hughes BR. Guidelines for the management of actinic keratoses. Br J Dermatol. 2007;156:222-230.

Eggermont AM, Suciu S, Santinami M, et al: EORTC Melanoma Group. Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final result of EORTC 18991, a randomised phase III trial. Lancet. 2008;372(9633):117-26.

Garcia C, Polette E, Crowson AN. Basosquamous carcinoma. J Am Dermatol. 2009;60(1):137-43.

Goodson AG, Grossman D. Strategies for early melanoma detection: Approaches to the patient with nevi. J Am Acad Dermatol. 2009;60(5):719-35: quiz 736-8. Review.

Guadagnolo BA, Zagars GK. Adjuvant radiation therapy for high-risk notal metastases from cutaneous melanoma. Lancet Oncol. 2009;10(4):409-16.

Hexsel, CL, Bangert SD, Hebert AA, et al. Current sunscreen issues: 2007 Food and Drug Administration sunscreen labelling recommendations and combination sunscreen/insect repellent products. J Am Dermatol. 2008;59(2):316-23. Review.

Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the surveillance, epidemiology, and end results (SEER) program. Arch Dermatol. 2008;144:515-521.

Lange JR, Fecher LA, Sharfman WH, et al. Melanoma. In: Abeloff MD, Armitage JO, Nierderhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone; 2008:chap 73.

Lautenschlager S, Wulf HC, Pittelkow MR. Photoprotection. The Lancet [early online publication]. May 3, 2007.

Markovick SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, et al. Malignant melanoma in the 21st century, part 1:epidemiology, risk factors, screening, prevention, and diagnosis. Mayo Clin Proc. 2007;82:364-380.

Markovick SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, et al. Malignant melanoma in the 21st century, part 2: staging, prognosis, and treatment. Mayo Clin Proc. 2007;82:490-513.

Morton CA, mckenna KE, Rhodes LE:British Association of Dermatologists Therapy Guidelines and Audit Subcomittee and the British Photodermatology group. Guidelines for topical photodynamic therapy: update. Br J Dermatol. 2008;159(6):1245-66. Review.

Morton DL, Thompson JF, Cochran AJ Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307-1317.

Olsen CM, Zens MS, Stukel TA, et al. Nevus density and melanoma risk in women: to test the divergent pathway hypothesis. Int J Cancer. 2009;124(4):937-44.

Ridky TW. Nonmelanoma skin cancer. J Am Acad Dermatol. 2007;57:484-501.

Savel MS, Wong SI. Review of evidence-based support for pretreatment imaging in melanoma. J Natl compr Canc netw. 2009;7(3):281-9. Review.

Suh KY, Bolognia JL. Signature nevi. J Am Acad Dermatol. 2009;60(3):508-14. Review.

Telfer NR, Colver GB, Morton CA. Guidelines for the Management of Basal Cell Carcinoma. BJD. 2008;159:35-48.

Tran KT, Wright NA, Cockerell CJ. Biopsy of the pigmented lesion-when and how. J Am Acad Dermatol. 2008;59(5):852-71. Review.

Treatment for Metastatic Ocular Melanoma. NCI Cancer Bulletin. March 7, 2006;3(10):8.

Vestergaard ME, Macaskill P, Holt PE, et al. Dermoscopy compared with naket eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008;159(3):669-76.

Warycha MA, Zakrzewski J, Ni Q, et al. Meta-analysis of sentinal lymph node positivity in thin melanoma. Cancer. 2009;115(4):869-79.

Wood GS, Gunkel J, Stewart D, et al. Nonmelanoma skin cancers: basal and squamous cell carcinomas. In: Abeloff MD, Armitage JO, Nierderhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone; 2008:chap 74.

Zeichner JA, Stern DW, Uliasz A, et al. Placebo-controlled double-blind randomized pilot study of imiquimod 5% cream applied once per week for 6 months for the treatment of actinic keratoses. J Am Acad Dermatol. 2009;60(1):59-62.

Reviewed last on: 7/30/2009
Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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