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Melanoma Treatment (PDQ®)
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General Information About Melanoma
Key Points:
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.
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. (Refer to 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. 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 or by other
conditions. 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).
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Stages of Melanoma
Key Points:
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.
The following stages are used for melanoma:
Stage 0 (Melanoma in Situ)
In stage 0, abnormal melanocytes are found in the
epidermis (outer layer of the skin).
These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.
Tumor size compared to everyday objects; shows various measurements of a tumor compared to a pea, peanut, walnut, and lime
Stage I
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 upper layer of the dermis.
- Stage IB: In stage IB, the tumor is either:
- not more than 1 millimeter thick, with ulceration, and
may have spread into the dermis or the tissues below the skin; or
- 1 to 2 millimeters thick, with
no ulceration.
Stage II
Stage II is divided
into stages IIA, IIB, and IIC.
- Stage IIA: In stage IIA, the tumor is either:
- Stage IIB: In stage IIB, the tumor is either:
- 2 to 4 millimeters thick, with ulceration;
or
- more than 4 millimeters thick, with no
ulceration.
- Stage IIC: In stage IIC, the tumor is more than 4 millimeters
thick, with ulceration.
Stage III
In stage III, the
tumor may be any thickness, with or without ulceration, and:
- has spread to 1 or more lymph nodes; or
- has spread into the nearby lymph system but not into nearby lymph nodes; or
- has spread to lymph nodes that are matted (not moveable); or
- satellite tumors (additional tumor growths within 2 centimeters of the original tumor) are present and nearby lymph nodes are involved.
Stage IV
In stage IV, the tumor
may be any thickness, with or without ulceration, may have spread to 1 or more nearby lymph nodes, and has spread to other places in the body.
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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.
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Treatment Option Overview
Key Points:
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. Before starting
treatment, patients may want to think about taking part in a clinical trial. 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.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
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:
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.
These include the following:
Chemoimmunotherapy
Chemoimmunotherapy is the use of anticancer drugs combined with
biologic therapy to boost the immune system to kill cancer cells.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
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Treatment Options by Stage
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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 clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 melanoma.
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Stage I Melanoma
Treatment of stage I
melanoma may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I melanoma.
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Stage II Melanoma
Treatment of stage II melanoma may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II melanoma.
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Stage III Melanoma
Treatment of stage III melanoma may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III melanoma.
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Stage IV Melanoma
Treatment of stage IV melanoma may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV melanoma.
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Treatment Options for Recurrent Melanoma
Treatment of recurrent
melanoma may include the
following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent melanoma.
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Changes to This Summary (09/20/2007)
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.
Editorial changes were made to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
