Understanding Melanoma

Melanoma is the least common skin cancer but the most important to catch early. It’s almost always curable when found early, but it can become deadly if allowed to spread. Important things to know:

  • Melanoma must be taken seriously. It is more likely than other skin cancers to spread.
  • Exposure to ultraviolet rays, from the sun or tanning beds, is a main cause of melanoma.
  • Oregon has a high rate of melanoma cases compared with other states.
  • Rates have been increasing for the past four decades.
  • Melanoma can strike anyone but is much more common in whites than in other races.
  • Melanoma is more common in older people but is also one of the most common cancers among young adults.
Diagram illustrating skin anatomy for understanding melanoma and other skin cancers

What is melanoma?

Melanoma is a type of cancer that arises from pigmented cells called melanocytes. It most often occurs in melanocytes in the skin’s top layer. Less often, melanomas form in other parts of the body, such as the eyes and mouth.

Who gets melanoma?

An estimated 96,480 new skin melanomas are expected to be diagnosed in the U.S. in 2019, according to the National Cancer Institute.

Causes and risk factors

Sun exposure: Damage from repeated exposure to ultraviolet rays — from the sun or sources such as tanning beds — is a factor in roughly half of melanomas. Ultraviolet rays damage the skin’s DNA, which can lead to cancer.

Family and medical history: About half of melanoma cases are linked to an inherited genetic trait. If a close relative — a parent, brother, sister or child — has had melanoma, you are at a slightly higher risk. Also, if you’ve had melanoma or basal or squamous cell skin cancer, you are at higher risk. OHSU offers expert genetic counseling and testing to learn about your risk and how to manage it.

Region: Oregon is among the top 10 states for melanoma cases. On average, more than 1,200 people a year were diagnosed with melanoma from 2011-15, according to the National Cancer Institute. That amounts to nearly 28 cases per 100,000 residents, or sixth-highest in the United States. Within Oregon, Deschutes County had the highest incidence, with 42 cases per 100,000 residents.

Race/ethnicity: Melanoma is 20 times more common in white people than in black people, and five times more common in white people than Latino people. If you’re white, your lifetime risk of getting melanoma is about 2.5%. White people with fair skin and with red or blond hair or blue or green eyes are at increased risk.

Age: About 70% of cases are diagnosed in people age 55 or older. At the same time, melanoma and breast cancer are the most common types of cancer among those ages 25 to 39.

Gender: Melanoma is more common in men, but that varies by age. For those younger than 50, women are at higher risk. For those older, men are.

Survival rates

Melanoma survival rate graphic showing that 92.2% survive at least 5 years

More than 92% of patients survive at least five years after diagnosis with melanoma. The rate is nearly 99% for patients diagnosed before the cancer has spread from its original site. Those diagnosed after cancer has spread to lymph nodes or other parts tend to have shorter survival times.

It’s important to remember that these are averages. Your outlook will vary based on factors specific to you. Five-year survival rates also reflect, by definition, treatments that were available five or more years ago.

Melanoma symptoms

Most moles are normal and harmless. But if you notice a mole that seems different, talk to your doctor. It’s important to be familiar with your own skin so you recognize when something looks different.

You can also use the ABCDE guide:

An asymmetrical melanoma

A. Asymmetry: One side is not like the other.

A melanoma with irregular edges

B. Border: The edges are irregular or ragged.

A melanoma with color variations

C. Color: It has color variations, such as shades of brown or black, sometimes with patches of pink, red or white.

An example of a melanoma, which is typically more than 6mm in diameter.

D. Diameter: It’s more than 6 millimeters across (the size of a pencil eraser), though it can be smaller.

An example of a mole that has changed in some way over time.

E. Evolving: The mole may change in size, color or shape.

Other symptoms to watch for:

  • A sore that doesn’t heal
  • Swelling or redness beyond the mole’s border
  • Itchiness, tenderness or pain at the mole
  • A mole that is scaly, that oozes or bleeds, or that includes a lump or bump

Types

Superficial spreading melanoma: This type accounts for about 70% of cases. It's the most common type in young people. The first symptom is a flat or slightly raised discolored patch with irregular borders. The patch may be tan, brown, black, red, blue or white. It can be anywhere on the body but is most likely on the upper back, or on the torso in men and the legs in women. This melanoma grows on the top skin layer for quite a while before invading deeper tissue.

Lentigo maligna: This type also stays close to the skin surface for a while. Most often, it appears flat or slightly elevated. It's most often tan, brown or dark brown. This type, which occurs in about 10-15% of melanoma cases, is most often found in the elderly.

Nodular melanoma: This type is often invasive by the time it is diagnosed. It often appears as a bump that’s usually black but sometimes brown, tan, red, white, blue or gray. This is found in 10-15% of melanoma cases and is the most aggressive type.

Acral lentiginous melanoma: This type occurs in 2-3% of melanoma cases. It usually appears as a black or brown discoloration under the fingernails or toenails or on the palms or on the soles of the feet. This type is most often found in dark-skinned people and is the most common melanoma in African Americans and Asians.

Staging

Staging helps guide treatment recommendations. Your care team will determine the stage based on:

  • How deeply the cancer penetrates your skin
  • Whether cancer has spread to your lymph nodes and/or other parts of your body

Stage I: The melanoma is less than 1 millimeter thick and is not found in the lymph nodes or other parts of the body.

  • Stage IA: The melanoma is less than 0.8 millimeter thick and does not have ulceration (an ulcer, or open sore).
  • Stage IB: The cancer is less than 0.8 millimeter thick and has ulceration, or it's 0.8 to 1 millimeter thick and ulcerated or not. 
Stage II Melanoma
A diagram illustrating Stage II melanomas

Stage II:  The melanoma is thicker but not in the lymph nodes or other parts of the body. 

  • Stage IIA: The melanoma is thicker than 1 millimeter but no thicker than 2 millimeters and is ulcerated. Or it’s thicker than 2 millimeters but no thicker than 4 millimeters and not ulcerated.
  • Stage IIB: The melanoma is thicker than 2 millimeters but no thicker than 4 millimeters and is ulcerated, or it's thicker than 4 millimeters and not ulcerated.
  • Stage IIC: The melanoma is thicker than 4 millimeters and ulcerated.

Stage III: Cancer may affect lymph nodes and/or nearby skin areas.

  • Stage IIIA: The melanoma is less than 0.8 millimeters thick and may or may not be ulcerated, or it's up to 2 millimeters thick and not ulcerated. Cancer affects as many as three lymph nodes.
  • Stage IIIB: One of the following:
    • There's no sign of a primary tumor, but cancer affects one lymph node or has spread to nearby skin areas.
    • The melanoma is less than 0.8 millimeter thick and may or may not be ulcerated, or it's up to 2 millimeters thick and not ulcerated. Cancer affects as many as three lymph nodes or affects nearby skin areas.
    • The melanoma is up to 2 millimeters thick and is ulcerated, or it's up to 4 millimeters thick and not ulcerated. Cancer affects as many as three lymph nodes, or it affects nearby skin areas.
  • Stage IIIC: One of the following:
    • There's no sign of a primary tumor. Cancer may affect up to four or more lymph nodes; matted (connected) nodes may be present; and cancer may have spread to nearby skin areas.
    • The melanoma is less than 0.8 millimeter thick and may or may not be ulcerated, or it's up to 4 millimeters thick and is not ulcerated. Cancer may affect up to four or more lymph nodes; matted nodes may be present; and cancer may have spread to nearby skin areas.
    • The melanoma is more than 2 millimeters thick but no more than 4 millimeters thick and is ulcerated, or it's thicker than 4 millimeters and not ulcerated. Up to one lymph node is affected, or cancer affects nearby skin areas.
    • The melanoma is thicker than 4 millimeters and ulcerated. Cancer affects up to one lymph node and nearby skin areas, or it affects as many as three nodes and no nearby skin areas.
  • Stage IIID: The melanoma is thicker than 4 millimeters and ulcerated. Cancer may affect as many as four or more lymph nodes; matted nodes may be present; and cancer may have spread to nearby skin areas.

Stage IV: The melanoma has spread to organs such as the lungs, liver or brain.

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