Updated 11 February 2021

What is Melanoma?

Patient skin check for Melanoma
Melanoma is a type of skin cancer that forms in the melanocytes or the pigment cells of the skin. It is the melanocytes that generate the melanin needed by the skin to protect it against harsh ultraviolet (UV) rays from the sun. A mole is a non-cancerous growth that is formed when a group of melanocyte cells in the skin cluster together. Though a majority of moles are safe in nature, there are still instances where the melanocytes that form moles react in an unpredictable manner. These melanocyte cells may start rapidly dividing and growing erratically, either outwardly where they are visible on the surface of the skin, or inwardly where they grow further down into the different skin layers. When this occurs, the unusual growth of these melanocytes would form into a cancerous skin condition known as a melanoma. This skin cancer can be very aggressive. The growth caused by melanoma can be both quick and large in size especially when early treatment is not forthcoming. In addition, this skin cancer may spread to the dermis (a lower layer of the skin) and then permeate through the bloodstream or even the lymphatic system where it further spreads to vital organs like the bone, kidneys, liver, lungs, and the brain. Hence early detection of melanoma is extremely important.

Symptoms of Melanoma

 Melanoma occurs in three stages and appears as:
  • A tumour or lesion on the epidermis (this is an in situ melanoma),
  • A tumour that spreads down to the dermis (this is an invasive melanoma), and
  • A tumour that spreads through tissues and organs (this is a metastatic stage).
Typically, the symptoms of melanoma include:
  • Colouration - melanoma can appear as a dark brown, blue, tan, black, light grey or red colour.
  • Itchiness - there are melanomas that tend to be itchy.
  • Tenderness - some melanomas are tender to touch.
  • Bleeding - there are melanomas that may easily bleed.

What is responsible for Melanoma?

 It is believed that melanoma may in some cases be hereditary. There are people that are at a high risk of developing melanoma if they have a family history of the condition. Other than genetics, melanoma is known to be caused by an overexposure to the harsh radiation from the ultraviolet rays of the sun. It may also occur in people who expose themselves to sunbeds and other similar devices whilst trying to get a tan. It is also believed that fair-skinned people are at a higher risk of developing melanoma, as well as individuals with more moles. There are known cases of melanoma developing not just on parts of the skin that are exposed to sunlight, but also on regions where the skin is not frequently exposed, such as the palm of a hand, sole of a foot or even in a person's mouth.

Diagnosing Melanoma

 A GP can physically examine the skin condition in its early stage. Based on the history, clinical features and appearance of the lesion, your doctor may be able to accurately diagnose the skin cancer as melanoma. However, some melanomas can be hard to clinically identify. A doctor will usually either take a small sample of the lesion for testing, or conduct a total excision and send the removed lesion for testing. Depending on the results of the pathology tests, a wider margin may need to be excised to ensure all of the melanoma has been removed. Other tests include blood tests, imaging such as CT, PET scan, X-ray, and MRI. However, for those patients suffering from stage 1 or 2 of this skin cancer, tests would not be necessary except where there are clear signs of a recurrence of the cancer or if metastasis has occurred.
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How is Melanoma Treated?

 Typically, surgery is recommended after a melanoma diagnosis and this usually involves a wide localised excision performed on the primary site of the melanoma. Surgery to remove melanoma may be extensive as it all depends on the location and size of the lesion. In Australia, there are recommended clinical margins for surgery depending on the size and site of the melanoma. Before surgery is performed, a melanoma specialist may perform 'melanoma staging'. This is where your doctor tries to find out the extent to which the skin cancer has expanded from the primary site to other parts of the body. Where there is a significant spread of melanoma, the extent of surgery may be much more extensive and may include other treatment like chemotherapy.

Recovery from Melanoma Surgery

Recurrence of melanoma is a real possibility, so follow-up checks and examinations are necessary after surgery. As with all cancers, early diagnosis is key to the level of success of treatment. Follow-up examinations will also help to detect any new melanoma, as it is known that an invasive secondary melanoma occurs in between 5 to 10% of patients. It is therefore important that you go for routine examinations as scheduled. Follow-up appointments may involve a physical examination by your doctor and this usually means:
  • A physical examination of the site and scar from the surgery,
  • The feeling of the lymph nodes around the site of the removed melanoma,
  • A thorough physical checkup, and
  • A complete examination of the skin.

Complications of Melanoma

 The thickness of the melanoma will increase the potential for metastasis with a 40% chance of metastasis occurring in melanomas that are larger than 4 mm in thickness. Melanoma that is surgically removed poses little or no risk of spreading throughout the body. However, melanoma that is invasive can greatly increase the chances of metastasis and eventually death.
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