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Melanoma


Expert reviewer Dr Anton Alexandroff, Consultant Dermatologist
Next review due January 2023

Melanoma is a type of skin cancer that can spread to other parts of your body. It may start in a mole on your skin, or it may start on normal skin creating a new, abnormal mole.

There are other forms of skin cancer, called non-melanoma skin cancer, which tend to be less serious than melanoma.

An image showing a diagram of skin cells

About melanoma

Melanoma is a cancer that forms in skin cells called melanocytes. These are cells mainly in the top layer of your skin which make a pigment called melanin. This pigment gives your skin its colour and helps to protect it from the harmful effects of the sunlight. Moles and freckles are benign (harmless) collections of melanocytes.

Most (but not all) melanomas happen where your skin has been exposed to sunlight. In about one in five people with melanoma, the cancer spreads to other parts of the body.

Around 16,000 people get melanoma each year in the UK, and the numbers are increasing. You can get melanoma at any age, but it’s more likely as you get older.

Types of melanoma

There are four main types of melanoma.

  • Superficial spreading melanoma. This is the most common type of melanoma. It appears as a flat, coloured lesion and spreads across the surface of your skin. It often appears on the back in men and on the lower legs in women.
  • Nodular melanoma. This usually looks like a dark-coloured lump on your skin which may ulcerate or bleed. Nodular melanomas tend to grow vertically into the skin (upwards and downwards) forming a raised lump, rather than flat across the surface. Because of this, they can spread to other areas of your body more rapidly.
  • Lentigo maligna melanoma. These often look like freckles at first and then slowly become quite dark with irregular colours such as dark brown, black and blue. They usually appear on your face or scalp.
  • Acral lentiginous melanoma. These melanomas are most common in people with darker skin types, but may also happen in people with white skin. They often appear on the palms of your hands, soles of your feet or under a nail.

Symptoms of melanoma

The first sign of melanoma is often the appearance of a new mole or a change in how one of your existing moles looks. If you notice a mole that stands out because it looks different from other moles or marks on your skin, you should get it checked out. This is especially important if the mole is changing in appearance.

The ABCDE checklist (below) includes a few warning signs that might indicate a mole is more likely to be a melanoma. If you have any doubt, it’s always best to check with a doctor.

  • A – asymmetry – one half looks different from the other.
  • B – border irregularity – the edges are uneven, blurred or jagged.
  • C – colour variability – the mole is a mixture of different colours.
  • D – diameter (width) – the mole is bigger than 6mm across.
  • E – evolution – the mole has changed suddenly or over time in size, shape or colour.

It’s also important to get checked if your mole changes in the way it feels; for instance, if it becomes itchy. You should seek medical advice too if you notice a dark area that’s getting bigger under a nail, and wasn’t caused by an injury.

Download our checking your mole infographic (PDF 1MB).

Graphic showing the five steps to checking your moles.

Diagnosis of melanoma

Your GP will examine any suspicious areas of your skin and ask you questions such as when you first noticed any changes. They’ll make an assessment of the mole to decide whether or not you need to see a dermatologist. A dermatologist is a doctor who specialises in skin conditions.

Seeing a specialist

If you’re referred to a dermatologist, you should get an appointment within a couple of weeks.

The dermatologist may first examine your mole with a tool called a dermatoscope. This is a special, hand-held magnifying glass that your doctor uses to view through the surface of your skin. Your doctor may also take some photos of the mole, so they can see if it changes over time.

If your dermatologist thinks your mole could be a melanoma, they’ll recommend you have an excision biopsy. This involves removing the whole mole, along with a narrow margin of normal skin, and sending it to a laboratory for testing. This biopsy is usually carried out under local anaesthesia, which means the skin will be numbed so you won’t feel anything.

Staging

Once it’s been removed, your mole will be examined to check if it’s a melanoma and, if it is, how advanced (what stage) it is. You may be asked to return for further tests to determine if your cancer has spread. Investigations you may have include the following.

  • A sentinel lymph node biopsy. This is a test to see if a melanoma has spread to your lymphatic system (part of your body’s immune system). The sentinel lymph node is the first lymph node that the cancer cells are most likely to spread to.
  • Scans. These may include CT (computerised tomography) scans, MRI (magnetic resonance imaging) scans and PET (positron emission tomography) scans. These scans can identify cancer that has spread to other parts of your body (metastases).

If you need any of these tests, your doctor will explain what’s involved and you’ll be able to ask any questions you have. To find out more about the stages of melanoma, see our section ‘Other helpful websites’ below for websites that give lots of information.

Treatment of melanoma

The treatment you’re offered will depend on what stage melanoma you have. This means how far it’s grown into your skin (the thickness) and whether or not it’s spread.

Surgery

Surgery is the main treatment for melanoma.

You will already have had your mole removed with an excision biopsy, in order to confirm your diagnosis. If it’s confirmed as a melanoma, you may be asked to come back for a second operation to remove more skin from around the area. This is called a wide local excision. It’s done to try to ensure that all the cancer cells are removed. You may need a skin graft or a skin flap to cover the area afterwards. For more information, see our FAQ: How is skin replaced after the cancer has been removed? below.

If a sentinel lymph node biopsy shows that cancer cells have spread to your lymph nodes, you may need surgery to remove them. This is called a lymphadenectomy or lymph node dissection. It involves removing all of your lymph nodes in the affected area, even healthy ones, to prevent the cancer spreading further or coming back.

If you have advanced melanoma that has spread, you might need more surgery to remove additional tumours in other parts of your body.

Non-surgical treatments

Early-stage melanoma

Surgical treatment is usually recommended, but if you have some types of very early-stage melanoma, it may be possible to have alternative treatments. These may be an option for you if you’re unable to have surgery for any reason or if surgery would seriously affect the way you look. Possible treatments include radiotherapy, scraping or freezing off the melanoma, or treatment with a cream called imiquimod. Your doctor can explain the risks and benefits of these treatments, and what’s involved.

Advanced melanoma

If you have advanced melanoma (which has spread), there are a number of treatments that your doctor may offer. These are listed below.

  • Immunotherapy – this involves treatment with intravenous medicines which work by stimulating your immune system to fight the melanoma.
  • Targeted therapies – these are medicines that work by targeting specific genes in the cancer cells to stop them growing and spreading. You may be able to have this treatment if your melanoma is shown to be positive for a genetic mutation called BRAF.
  • Chemotherapy – you may be offered chemotherapy if other treatments aren’t thought to be suitable. Chemotherapy isn’t used very often in the treatment of melanoma though.
  • Radiotherapy – you may be offered radiotherapy to treat melanoma that has spread to other parts of your body, such as your brain or bones.

Causes of melanoma

The things that increase your risk of getting melanoma include the following.

  • Sun exposure. A lot of exposure to sunlight and tanning beds puts you at risk of getting melanoma. Melanoma also seems to be linked to having had episodes of severe sunburn as a child or teenager.
  • Your moles. The more moles you have, the higher your risk of getting melanoma. And people who have lots of unusually shaped moles have a higher risk. Melanoma doesn’t necessarily start in one of your moles, but having lots of moles is linked to being more likely to get melanoma.
  • Having had skin cancer before, including non-melanoma skin cancer.
  • Members of your close family having had melanoma. In around one in 10 melanomas, there’s a family history of melanoma.
  • Having pale skin that burns easily, red or blonde hair, or blue or green eyes.
  • Getting older – your risk of getting melanoma increases with increasing age.
  • Having a weak immune system, for instance because you’re taking medicines after an organ transplant.

It’s important to regularly check your skin and moles. It’s even more important to check your skin if you have any of the factors that put you at greater risk of melanoma. For information to help you, see our section on symptoms above. Try to check monthly if you can. If you see any changes in your skin, it’s important that you contact your GP.

Prevention of melanoma

Most cases of melanoma could be prevented by following steps to be safe in the sun. The following tips may help to protect your skin from burning and reduce your risk of skin cancer.

  • Cover up with suitable clothing, including a wide-brimmed hat and ultraviolet-protective sunglasses.
  • Stay in the shade or cover up between 11am and 3pm, when the sunlight is most intense, rather than relying on sunscreens alone.
  • Use high-factor sunscreen if you are out in strong sunlight, with a sun protection factor (SPF) of at least 30, and high UVA protection (at least 4 stars).
  • Don’t use tanning beds to get a suntan.

Frequently asked questions

  • How successful your treatment for melanoma will depend mainly on the stage of melanoma you have when you’re diagnosed. This means how deep into the skin it has grown, and whether or not it has spread.

    Most people are diagnosed with early stage melanoma, where surgery has a very good chance of getting rid of the cancer. If your cancer has spread, it can be difficult to treat. But treatments for advanced melanoma are improving all the time. The newer medicines being used these days seem to be helping more people to survive.

    Like most cancers, there’s a chance your melanoma can come back after treatment. Your doctor is the best person to talk to you about the outlook in your particular circumstances.

    Remember – being aware of the signs of melanoma and seeking treatment early will give you the best chance of surviving the disease.

  • When you have melanoma surgically removed, some of your healthy skin is removed from around the tumour. Usually, the wound from surgery can be closed with stitches. But if the area is too large to close this way, the skin may be replaced with a skin graft or skin flap.

    Skin graft

    A skin graft is a thin layer of skin taken from another area of your body and placed over the area where the melanoma was removed. A graft is usually held in place with stitches and a dressing placed over it. After it has healed, the skin may look different from your surrounding skin and may be a slightly different colour.

    The area that the healthy skin was taken from will either be closed with stitches or left to heal by itself under a special dressing. It may feel sore, and can take up to two weeks to heal, depending on where the skin was taken from.

    Skin flap

    A skin flap is a thicker layer of skin than a graft. It’s taken from an area close to where your melanoma has been removed. The blood supply to the skin flap is left intact – this will help it to heal. The flap is held in place with stitches and a dressing will be placed over it.

    Skin flaps may give a better cosmetic result (look better). So you may be offered a skin flap if the wound is on an area where appearance is important, such as your face.

    Your surgeon will discuss which option is best for you and will explain what’s involved in these procedures.

  • Not necessarily, but getting sunburnt increases your risk of developing melanoma. Sunburn is when your skin goes red or pink in sunlight – it’s doesn’t necessarily have to peel for your skin to be damaged.

    Melanoma is more common in people who expose their skin to the sun from time to time, rather than continuously. For example, at weekends or when they’re on holiday, rather than spending regular time in sunlight every day. Melanoma is more likely to develop on areas of your body that are exposed to the sun intermittently – such as your back or legs.

    Because the effects can be so damaging, it’s really important to avoid sunburn. For tips on how to stay safe in the sun, see our section on Prevention above.


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Related information

    • Melanoma. BMJ Best practice. bestpractice.bmj.com, last reviewed November 2019
    • Skin anatomy. Medscape. emedicine.medscape.com, updated November 2017
    • Malignant melanoma of skin. Patient. patient.info, last edited August 2015
    • Melanoma. The MSD Manuals. www.msdmanuals.com, last full review/revision March 2019
    • Melanoma and pigmented lesions. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2017
    • Skin cancers – recognition and referral. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2016
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), 2015 (updated 2017). www.nice.org.uk
    • Melanoma: assessment and management. National Institute for Health and Care Excellence (NICE), 2015. www.nice.org.UK
    • Skin cancers. Oxford Handbook of Oncology (online). Oxford Medicine Online. oxfordmedicine.com, published online October 2018
    • Melanoma skin cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed October 2015
    • Am I at risk of sunburn? Cancer Research UK. www.cancerresearchuk.org, last reviewed April 2019
    • Surgery for mole removal. Macmillan Cancer Support. www.macmillan.org.uk, reviewed December 2016
    • The sunscreen fact sheet. British Association of Dermatologists. skinhealthinfo.org.uk, accessed December 2019
    • Types of surgery for larger skin cancers. Cancer Research UK. www.cancerresearchuk.org, last reviewed August 2017
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, January 2020
    Expert reviewer Dr Anton Alexandroff, Consultant Dermatologist
    Next review due January 2023



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