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Malignant Melanoma

Malignant Basics

Melanoma is a serious form of skin cancer that begins in melanocytes, the pigment-producing cells in our outermost layer of skin. Melanoma is less common than both basal cell carcinoma and squamous cell carcinoma, but more dangerous due to its ability to spread to other organs more rapidly if not treated at an early stage. Due to this fact, early diagnosis and treatment of melanoma is crucial.

More than 1 million people are living with melanoma, and one person dies of the disease every hour. However, the estimated five-year survival rate for U.S. patients whose melanoma is detected early is about 98 percent. The survival rate drops to 63 percent if the disease has reached the organs and 20 percent if it has spread to the lymph nodes.

Melanoma Risk Factors

Risk factors for melanoma include:

  • Already diagnosed atypical moles
  • Unprotected or excessive UV exposure, either from the sun or from indoor tanning
  • A weakened immune system due to a medical condition or medications
  • Many moles or large moles: The more moles you have, the higher your risk. Having moles larger than the tip of a pencil also puts you at increased risk.
  • Fair skin
  • Family history and genetics

Melanoma Prevention & Detection

We recommend you remain vigilant to both prevent and detect melanoma in its earliest and most easily treatable stages.

Preventative measures include:

  • Stay out of the sun, especially between peak sunlight hours between 10 a.m. and 4 p.m.
  • Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses
  • Apply broad-spectrum (UVA/UVB) sunscreen with an SPF of 35 or higher to your entire body 30 minutes before going outside. For extended outdoor activity, use a water-resistant, broad-spectrum sunscreen with an SPF of 35 or higher. Reapply every two hours or immediately after swimming or heavy sweating.
  • Do not burn, tan or use tanning booths
  • Keep newborns out of the sun. Use sun protection on babies age 6 months and older.

Melanoma can appear as an existing mole or as a new lesion. When it begins as a mole that is already on the skin, it tends to grow on the surface of the skin for some time before penetrating more deeply. While melanoma can be found anywhere on the body, it is most likely to appear on the torso in men, on the legs in women and the upper back in both men and women.

If you have any of the risk factors listed above, we recommend performing a monthly skin self-exam to aid in the early detection of melanoma. You can get a free self-exam worksheet here.

When you perform your self-exam, check all your spots for the ABCDE’s of melanoma:

  • A. Asymmetrical: If you could fold the spot in half, the sides would not match.
  • B. Uneven Border: Moles tend to have a smooth, even border. By contrast, melanoma tends to have a jagged (or uneven) border.
  • C. Color: Is varied from one area to another; has shades of tan, brown or black, or is sometimes white, red or blue.
  • D. Diameter: Melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller.
  • E. Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color.

In addition to regular self-exams, schedule a skin cancer screening annually to have us perform a professional full-body cancer screening. Make your appointment now.

Melanoma Diagnosis

When you visit our office because you’ve noticed a suspicious-looking spot on your skin, your dermatologist will first perform a physical exam and gather information about your health history. Then, depending upon this evaluation, your dermatologist may remove a portion of the lesion if he or she suspects the potential for skin cancer. This is called a skin biopsy. A biopsy is essential because it’s the only way to determine the presence of skin cancer with 100 percent certainty.

A pathologist will examine the skin your dermatologist has removed under a microscope, looking for skin cancer cells. The pathologist will then provide a biopsy report to your dermatologist to direct our next steps of treatment

It can take one to two weeks for your dermatologist to receive and review your biopsy report. These results will guide further followup or treatment. If a diagnosis of skin cancer is confirmed, we will help you determine the most appropriate course of care.

Melanoma Treatment

Your biopsy will determine the subtype and stage of your melanoma, which will guide our treatment. In its early stages, melanoma can be treated with surgical excision with microscopic margin control. This multi-day step by step surgical treatment is similar to Mohs surgery where the entire margin is carefully examined, but the tissue is processed overnight for the highest identification of the melanoma cells. This will give the highest cure rate, especially on the head and neck and other areas of extensive sun damage.

If your melanoma is more invasive, further diagnostic tests will be necessary, such as lymph node biopsy or CT/PET scans to help determine if the cancer has spread beyond the skin. If these confirm that your melanoma has spread, more aggressive surgeries and systemic treatments may be necessary.


Frequently Asked Questions

What is a melanocyte?

Melanocytes are skin cells found in the upper layer of skin. They produce a pigment known as melanin, which gives skin its color. There are two types of melanin: eumelanin and pheomelanin. When skin is exposed to ultraviolet (UV) radiation from the sun or tanning beds, it causes skin damage that triggers the melanocytes to produce more melanin, but only the eumelanin pigment attempts to protect the skin by causing the skin to darken or tan. Melanoma occurs when DNA damage from burning or tanning due to UV radiation triggers changes (mutations) in the melanocytes, resulting in uncontrolled cellular growth.

What does melanoma look like?

Look for anything new, changing or unusual on both sun-exposed and sun-protected areas of the body. Melanomas commonly appear on the legs of women, and the number one place they develop on men is the trunk. Keep in mind, though, that melanomas can arise anywhere on the skin, even in areas where the sun doesn’t shine.
Most moles, brown spots and growths on the skin are harmless – but not always. The ‘ABCDE’s’ and the ‘Ugly Duckling’ sign can help you detect melanoma.

How dangerous is melanoma?

Melanoma is usually curable when detected and treated early. Once melanoma has spread deeper into the skin or other parts of the body, it becomes more difficult to treat and can be deadly.

  • The estimated five-year survival rate for U.S. patients whose melanoma is detected early is about 98 percent.
  • An estimated 7,230 people (4,740 men and 2,490 women) will die of melanoma in the U.S. in 2019.

How widespread is melanoma?

An estimated 192,310 cases of melanoma will be diagnosed in the U.S. in 2019. Of those, 95,830 cases will be noninvasive and confined to the top layer of skin (in situ). 69,480 cases will be invasive, penetrating into the skin’s second layer.
What are the four main types of melanoma of the skin?

What are the main types of melanoma of the skin?

Superficial spreading melanoma
What you should know: This is the most common form of melanoma.
How and where it grows: It can arise in an existing mole or appear as a new lesion. When it begins in a mole that is already on the skin, it tends to grow on the surface of the skin for some time before penetrating more deeply. While it can be found nearly anywhere on the body, it is most likely to appear on the torso in men, the legs in women and the upper back in both.
What it looks like: It may appear as a flat or slightly raised and discolored, asymmetrical patch with uneven borders. Colors include shades of tan, brown, black, red/pink, blue or white. It can also lack pigment and appear as a pink or skin-tone lesion (amelanotic).

Lentigo maligna
What you should know: This form of melanoma often develops in older people. When this cancer becomes invasive or spreads beyond the original site, the disease is known as lentigo maligna melanoma.
How and where it grows: This form of melanoma is similar to the superficial spreading type, growing close to the skin surface at first. The tumor typically arises on sun-damaged skin on the face, ears, arms or upper torso.
What it looks like: It may look like a flat or slightly raised, blotchy patch with uneven borders. Color is usually blue-black, but can vary from tan to brown or dark brown.

Acral lentiginous melanoma
What you should know: This is the most common form of melanoma found in people of color, including individuals of African ancestry.
How and where it grows: It often appears in hard-to spot places including under the nails and on the soles of the feet or palms of the hands.
What it looks like: It may appear as a black or brown area.