As with any other form of cancer, skin cancer isn’t a single disease. Rather, the term refers to a family of diseases related to the overgrowth of certain types of skin cells, also called epidermal cells. There are several different types of skin cancer that can occur, but the deadliest among them is a form of skin cancer called melanoma.
“Melanoma is a cancer of a specific type of skin cell, called melanocytes. Those are the cells that make pigment, and melanoma is an overgrowth of those cells,” says Dr. Pauline Funchain, a medical oncologist who specializes in melanoma at the Cleveland Clinic in Ohio. The pigment that the melanocytes produce is called melanin, and it’s responsible for the color of our skin, hair and eyes. Melanocytes also produce noncancerous growths or spots called moles that are usually darker than a person’s typical skin tone or brown in color. Melanomas often occur in moles or alongside them. The majority of melanomas appear black or brown, but they can also appear to be skin-colored, pink, red, purple, blue or white.
Although scientists aren’t sure exactly why, melanoma tends to be a very aggressive form of cancer that is more likely to spread to other areas of the body. The Centers for Disease Control and Prevention reports that in 2015 (the most recent year for which data are available) 80,442 new cases of melanoma of the skin were reported and 8,885 people died of the disease.
[See: 7 Ways to Prevent Skin Cancer.]
What Causes Melanoma?
The exact cause of melanoma is not clear, and as with any form of cancer, it’s difficult to point to a single cause for any individual case of melanoma. However, there are certain hereditary and lifestyle factors — a family history of melanoma and smoking, for example — that can increase your risk of developing melanoma. Melanoma has also been linked to excessive exposure to ultraviolet rays from sunlight, tanning beds or tanning lamps.
What Are the Risk Factors for Melanoma?
People who have a lot of exposure to UV radiation, which comes from the sun, are at higher risk for developing melanoma. This is because UV radiation can damage genes in skin cells, leading to mutations that may cause cancer in some individuals. This risk is higher among people with fair skin, light hair and green or blue eyes — their bodies simply have less melanin, which is a natural form of protection against the hazardous effects of sunlight.
Other risk factor that may increase your chance of developing melanoma include:
— Living in areas close to the equator or at high altitudes where radiation levels are higher and warmer temperatures typically mean people wear less clothing.
— Having long-term exposure to UV rays because of a job (lifeguards, for example) or other activities.
— Having had one or more episodes of blistering sunburn during childhood. Funchain says that the deleterious effects of a bad or blistering sunburn “seems to have more effect when skin is younger.”
— Using tanning beds or lamp devices. These devices expose the skin to UV radiation, just like tanning in the sun does. As with sunburns, the risk of developing melanoma from tanning is greater for younger people than older people, Funchain says. “It’s very interesting. If you look at the amount of increased risk from tanning beds, the risk is way higher if the tanning bed exposure is in somebody’s 20s versus 30s versus 40s. At all ages, tanning beds increase the risk of skin cancers and melanomas but that risk is much, much higher when you’re in your teens or 20s,” she says.
— Having fair or freckled skin, blue or green eyes and red or blonde hair.
— Spending lots of time outdoors without the use of sun protection.
— Having a family or personal history of melanoma. “We’re conducting a familial melanoma study here and we’re starting to understand that there’s a bigger proportion of melanoma that’s inherited than we thought,” Funchain says. So, ask your parents, grandparents and siblings about whether they’ve ever had skin cancer or melanoma.
— Being exposed to chemicals that can cause cancer, such as arsenic, coal tar and creosote.
— Having multiple moles, the presence of certain types of moles or multiple birthmarks.
— Having a weakened immune system or immunodeficiency disorder such as AIDS, autoimmune disorders such as rheumatoid arthritis or having had an organ transplant.
— Smoking cigarettes.
Melanoma Warning Signs
According to the National Cancer Institute, the first sign of melanoma is often a change in the shape, size, color or texture of an existing mole. Melanoma may also appear as a new mole or change in skin. Many skin care experts recommend the ABCDE method to help people look for and detect possible melanomas:
— A: Asymmetry. If a mole or spot is irregular or asymmetrical in shape, that’s cause for concern.
— B: Border. A jagged or irregular border around a mole or darker spot on the skin could also be a sign of cancer.
— C: Color. Is the mole or spot darker in one area versus another? Uneven color can signify a problem.
— D: Diameter. The larger a spot or mole is, the more likely it is to be cancer. If it’s larger than the size of a pea, definitely get it checked out.
— E: Evolving. If your questionable mole or spot has changed recently, talk to your doctor.
The Skin Cancer Foundation also recommends comparing moles and spots on the skin to others nearby to determine if a particular mole is an “‘ugly duckling.’ The premise is that the patient’s ‘normal’ moles resemble each other, like siblings, while the potential melanoma is an ‘outlier,’ a lesion that, at a given moment in time, looks or feels different than the patient’s other moles, or that over time changes differently than the patient’s other moles.”
Any change in your skin such as the development of a new mole, spot, lump or a sore that won’t heal should be checked out by your health care provider.
[See: 9 Surprising Facts About Sunscreen.]
Diagnosing Melanoma
If you see any changes in the color, texture, size or appearance of your skin or a mole, you should immediately contact your primary health care provider to have your skin examined. You may be referred to a dermatologist. Your health care provider will look at the area and may order a biopsy to confirm the diagnosis. The biopsy may involve removing a small part of the affected area or the entire growth.
Once a melanoma has been confirmed, your doctor may also order CT (computed tomography) scans or other types of imaging tests and lab work to determine if the cancer has spread.
Treating Melanoma
The stage and location of the melanoma and your overall health will determine which type of treatment plan your doctor will recommend. The National Cancer Institute notes that “when abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread,” a condition called metastasis that can be life-threatening. If detected early, sometimes the removal of the affected area and surrounding tissues is all that is needed.
Funchain says “the vast majority of melanomas are (diagnosed) in stage 1, while they’re still small, thin melanomas. They can be excised, and surgery is curative in well over 90 percent of cases. Most people with a melanoma will never have to worry about it again.” However, there are a small proportion of people diagnosed with stage 1 melanoma that will progress to later-stage disease despite treatment. She says that many people with stage 1 melanoma can work with their dermatologist to treat it, but some may be referred to a medical oncologist — a cancer specialist — for further evaluation. People with later-stage melanoma typically are referred to a medical oncologist for treatment.
If the cancer has spread or is diagnosed in a later stage, such as stage 3 or 4, these cases typically result in more aggressive treatment. These patients may require surgery, chemotherapy or radiation, or newer treatments such as immunotherapy or targeted therapy, both of which have improved outcomes and extended survival times for patients with late-stage melanoma. Immunotherapies are new drugs that help leverage the body’s immune system to fight cancer itself.
Funchain says “I wish more people knew that immunotherapy is out there and it’s different from chemotherapy. It’s not at all the same drugs and not at all the same side effects.” Immunotherapies typically have fewer side effects than more conventional cancer treatment regimens and in many cases, have proven to be more effective. “It’s made a huge change in outcomes for people who’ve been diagnosed with melanoma,” she says.
“In addition to immunotherapy there’s a whole other branch of treatment called targeted therapy.” This approach is opening up new possibilities for people with melanoma by taking aim at a specific part of the melanoma cells to kill them and stop the disease from spreading. “Not all melanomas respond to it, but about half do, and that has also really greatly helped change the outcome for people who’ve been diagnosed with melanoma.” As with immunotherapies, targeted therapies tend to have fewer side effects than conventional chemotherapy and radiation treatment protocols. “All of these changes have radically changed what we see in melanoma and the survival in melanoma. People do of course still die of melanoma, but it’s getting better,” she says.
Because treatment of melanoma is evolving so rapidly, Funchain recommends that people dealing with the disease find good sources of information or work with a medical oncologist who specializes in the treatment of melanoma to make sure to gain access to the latest innovations. “Treatment of melanoma is changing so quickly — there are literally two or three new findings every year that change what we do as melanoma specialists. Whereas with certain cancers, what we did this year is what we did five years ago, that is not true in melanoma. Things are constantly changing for the better.”
Prevention of Melanoma
As the saying goes, an ounce of prevention is worth a pound of cure, and this is true for melanoma. Avoiding it is always better than having to treat it, no matter how good the newer treatments may be.
Although the U.S. Preventive Services Task Force has concluded that there’s not enough evidence to recommend routine skin cancer screening by a doctor, many health care professionals still urge people — especially those who have a personal or family history of skin cancer — to have a dermatologist or other health care provider conduct an annual skin check to spot signs of skin cancer earlier. (A skin check is a thorough visual examination of all your skin conducted by a dermatologist or other health care provider.)
Routine self-examination is also recommended. You should examine your skin at least once a month, and contact your primary health care provider if you find any unusual changes in any moles or areas of skin.
[See: What Causes Cancer? 5 Unlikely Claims Explained.]
Other steps that you can use to prevent or reduce your chances of melanomas include:
— Avoid excessive exposure to the sun, especially between the peak hours of 10 a.m. and 2 p.m. Seek shade when you can.
— Avoid using tanning beds or lamp devices.
— Always wear sunglasses to protect your eyes, because melanoma can occur in the pigmented area of the eyes.
— Always apply sunscreen 15 to 30 minutes before going outdoors to protect skin, and wear hats and protective clothing to protect against UV rays. The American Academy of Dermatology recommends that everyone use a broad-spectrum sunscreen that offers protection against UVA and UVB rays, that’s water-resistant and that has a sun protection factor (SPF) of 30 of higher. (UVA rays penetrate into the dermis, the skins thickest layer. UVB rays can damage the top layers of skin. Both can be a factor in the development of skin cancer.)
— Reapply sunscreen every two hours, especially if you’re sweating. Reapply immediately after swimming even if the product is labeled as “water-resistant” or waterproof.”
— Routinely examine your skin for changes in moles. Consider visiting your dermatologist annually for a thorough skin check to look for any signs of melanoma.
— Always consult your doctor if you notice any changes in your skin or a mole.
Funchain says the advice we’ve been getting all along about covering up with long sleeves, a wide-brimmed hat and sunblock is still a great way to reduce your risk of developing melanoma and other skin cancers, because skin cancer is so often related to UV radiation exposure. “UV is part of the equation, and it helps for people to try to reduce their exposure to UV radiation. It doesn’t mean you have to hide in basements and never see the sun or never go on a beach vacation, but you do want to try to use sunscreen, use sun-protective clothing, wear the big-brimmed hats, especially if you’re fair-skinned, have fair eyes or hair. Those characteristics will make skin more sun sensitive.” The added bonus of covering up when you’re in the sun? “It helps with the aging process, so why not look younger?”
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Melanoma: Prevention, Warning Signs and Treatment originally appeared on usnews.com
Update 02/04/19: This article was originally published on Aug. 10, 2013. It has been updated.
