Melanoma of the skin (cutaneous melanoma) is the most serious form of skin cancer. It develops from melanocytes in the skin. Melanocytes produce melanin, the pigment responsible for skin color. Melanoma can arise in the nailbed, eye (ocular melanoma), mucous membranes of the anus and genitalia, nasal and sinus membranes, and very rarely in internal organs.
Melanoma: what you should know
- All cutaneous melanomas appear as a new or changing spot, bump, mass, patch or freckle. Melanoma may occur in any racial group, regardless of skin color, anywhere on the skin, nail bed, or mucous membranes.
- The deadliest form of melanoma, which comprises about 20 percent of cases, may be red or uniformly black, round and have a consistent color. It may be relatively small at its outset, even smaller than a dried lentil bean.
- The most common site for cutaneous melanoma is the torso for men and women. It is somewhat more common on the legs of women and the upper backs of men.
- While sun exposure has been associated with skin damage and most skin cancers (basal cell cancer and squamous cell cancer), only about 10 percent of melanomas in climates similar to Chicago are caused by ultraviolet radiation (or sunlight). About half of all melanomas in nonwhites occur in the following areas:
- Palms of hands
- Soles of feet
- Nail beds
- Anus and genitalia
Melanoma risk factors
The most important risk factors for developing melanoma of the skin include the following:
- A personal history of a prior melanoma
- A family history of melanoma in a first-degree blood relative
- The presence of atypical/prominent numbers of moles
- A history of an abnormal mole removed in the past
- A personal history of basal cell cancer or squamous cell cancer, and very heavy sun-induced freckling
Care for cutaneous melanoma at Rush
Early diagnosis and treatment of cutaneous melanoma are crucial. The stages of melanoma range from 0 (malignant cells confined to epidermis, the outer layer of the skin) to IV (malignant cells have spread from the skin to other parts of the body).
The 10-year survival rate for patients diagnosed with melanoma at stage 0 is 100%, and stage IA about 97 percent. For patients diagnosed with melanoma at stage IV, the 10-year survival rate is 10 to 15 percent.
Diagnosing early and curable melanoma usually involves the following:
- A total mucocutaneous examination (total skin surface, nails, and mucous membranes, including hairy scalp, anus, and genitalia). This examination may be conducted by your own physician, a dermatologist, or a specialist (such as a medical oncologist or surgeon).
- For suspicious lesions, a biopsy may be obtained to remove abnormal tissue and a small amount of normal tissue that surrounds it. A pathologist examines this tissue under a microscope to check for cancer cells.
- Special testing of cancer cells for genetic changes that will help dictate treatment (for selected patients who are at risk or have already been found to have metastatic disease).
Determing melanoma stages
Determining the stage of your melanoma depends on the following factors:
- The microscopic thickness of the lesion and other features of the tumor, patient sex and age, and where the tumor is located
- Whether there was bleeding or broken skin (ulceration) in the tumor
- Whether the melanoma has spread to lymph nodes or other sites in the body
Treatment depends on the stage at which you are diagnosed. Recommended treatments might include one or more of the following:
- Surgery to remove the melanoma. This is the primary treatment for melanoma at any stage. Your physician will remove the primary lesion and a margin of the healthy tissue that surrounds it.
- Immunotherapy. For patients who have metastatic disease, immunotherapy, or biotherapy, uses your immune system to help fight melanoma by repairing, stimulating or enhancing your body’s immune responses to cancer cells.
- Chemotherapy uses oral or intravenous drugs to attack cancer cells that have already spread beyond the skin (e.g., to lymph nodes or other organs).
- Radiation therapy is not used to cure melanoma but can be used to help relieve symptoms if the cancer has spread to areas such as the bones or brain.
Why choose Rush for melanoma care
- Part of the Department of Dermatology, the Melanoma Surveillance Clinic at Rush is a leader in the use of photographic surveillance to detect new and changing skin lesions in patients at a very high risk of developing cutaneous melanoma.
- The cancer program at Rush was recently ranked among the top 50 hospitals in the country by U.S. News & World Report.
- The cancer program at Rush was awarded a 2014 Outstanding Achievement Award from the American College of Surgeons’ Commission on Cancer. Rush has received this triennial award each of the four times the Medical Center has been evaluated by the Commission on Cancer since the award was established.