Melanoma - Early Signs, Risk Factors, Diagnosis, and Treatment Explained

Melanoma is the most serious form of skin cancer, beginning in the pigment-producing cells of the skin known as melanocytes. Although less common than other skin cancers, melanoma can spread quickly if not detected early, which makes awareness and timely treatment crucial. This guide is designed to provide clear, compassionate, and easy-to-understand information about melanoma—its symptoms, how it is diagnosed, treatment options, and what you can expect throughout the journey. Our goal is to help you feel informed, supported, and empowered to face this challenge with confidence and hope.

What Is Melanoma?

Melanoma is a serious type of skin cancer that starts in the melanocytes. These are the specialized cells in the skin that produce melanin, the pigment that gives skin its color. While melanocytes are found all over the body, they are most concentrated in moles and other pigmented spots. Melanoma occurs when these cells become abnormal and begin to multiply uncontrollably, forming a malignant tumor.

While melanoma is not the most common type of skin cancer (that would be basal cell carcinoma), it is the most aggressive and dangerous. If left untreated, it has a high risk of spreading to other parts of the body (metastasis), such as the lymph nodes, lungs, liver, and brain, which can be life-threatening. However, the good news is that when found and treated in its earliest stages, melanoma is almost always curable. This is why early detection is so critical.

The majority of melanomas are caused by exposure to ultraviolet (UV) radiation from the sun or from tanning beds. A key part of managing your health is learning how to protect your skin and how to spot a suspicious mole or lesion.

Types of Melanoma

Melanoma is not a single disease. It is a diverse group of tumors that are classified based on their appearance, location, and growth pattern. The main subtypes include:

• Superficial Spreading Melanoma: This is the most common type of melanoma, accounting for about 70% of all cases. It typically grows outward and spreads across the surface of the skin before it starts to grow deeper. It often appears as a flat, irregularly shaped patch with uneven borders and multiple shades of red, blue, brown, or black.
• Nodular Melanoma: This is the second most common type and is considered more aggressive because it grows deeper into the skin more quickly. It typically appears as a raised, dome-shaped lump that is usually black, but can also be red, pink, or skin-colored. Nodular melanomas are often found on the head, neck, and trunk.
• Lentigo Maligna Melanoma: This type is most common in older adults. It usually appears as a large, flat, tan or brown patch on sun-damaged skin, such as the face, ears, and arms. It tends to grow outward across the surface of the skin for many years before it starts to grow deeper.
• Acral Lentiginous Melanoma: This is a rare type of melanoma that is more common in people with darker skin tones (people of Asian, African, and Hispanic descent). It is not related to sun exposure and appears on the palms of the hands, the soles of the feet, or under the fingernails or toenails.
• Amelanotic Melanoma: This is a less common form of melanoma that has no color. It can be pink, red, or skin-colored, which can make it very difficult to diagnose.

What Are the Causes and Risk Factors for Melanoma?

The primary cause of melanoma is damage to the DNA of the melanocytes from exposure to ultraviolet (UV) radiation. This damage can come from the sun or from indoor tanning equipment.

Key Risk Factors:

• UV Exposure and Sunburns: This is the single biggest risk factor. A history of severe, blistering sunburns, especially in childhood, significantly increases the risk of melanoma. Tanning beds also emit harmful UV rays and increase the risk.
• Skin Tone: People with fair skin, light-colored eyes, and blonde or red hair have a higher risk of developing melanoma.
• Moles: Having many moles (more than 50) or having atypical moles (dysplastic nevi), which are larger and have irregular shapes, increases the risk of melanoma.
• Family History: A family history of melanoma increases a person's risk. If a close relative (parent, child, or sibling) has had melanoma, you have a greater chance of developing it as well.
• Age: The risk of melanoma increases with age, but it is also one of the most common cancers in people under 30.
• Weakened Immune System: A compromised immune system is a major risk factor. This includes people who have had an organ transplant and are taking immunosuppressant medications, and people with HIV/AIDS.
• Large Congenital Moles: Having an unusually large mole at birth can increase the risk of melanoma later in life.

It's important to remember that people of all skin tones can get melanoma, and many people who get it do not have any of these known risk factors.

What Are the Symptoms of Melanoma?

The most common sign of melanoma is a new or changing spot on the skin. This is why it is so important to perform regular skin self-exams. A key tool for identifying a suspicious mole or lesion is the ABCDE rule.

1. A - Asymmetry: The two halves of the mole do not match.
2. B - Border: The edges are irregular, jagged, or notched.
3. C - Color: The color is uneven or patchy, with shades of brown, black, white, red, or blue.
4. D - Diameter: The spot is larger than 6 mm (about the size of a pencil eraser).
5. E - Evolving: The mole or spot is changing in size, shape, or color.

Other Common Early Signs:

• A sore that doesn't heal.
• A spot that becomes itchy or bleeds.
• A spot that feels different from the rest of your skin.

Advanced Symptoms:

If melanoma has spread to other parts of the body, symptoms may appear depending on where the cancer has spread.

• Swollen Lymph Nodes: Hard or swollen lymph nodes, especially in the armpit, neck, or groin.
• Bone Pain: Persistent bone pain.
• Unexplained Weight Loss: Losing weight without trying.
• Persistent Cough or Shortness of Breath: If the cancer has spread to the lungs.
• Headaches or Seizures: If the cancer has spread to the brain.

If you notice a new or changing spot on your skin, or any of the advanced symptoms, it is crucial to see a dermatologist for a proper evaluation. Early detection is the key to a positive outcome.

How Is Melanoma Diagnosed?

Diagnosing melanoma requires a thorough physical exam and specialized tests. The process often begins when a patient notices a suspicious mole or a doctor sees one during a routine skin check.

Diagnostic Steps and Tests:

1. Physical Exam: A dermatologist will perform a thorough skin exam, looking at all of your skin, including areas that are not typically exposed to the sun. They may use a special magnifying tool called a dermatoscope to get a closer look at the lesion.

2. Skin Biopsy (The Definitive Test): A biopsy is the only way to definitively diagnose melanoma. A small sample of the suspicious lesion is removed and sent to a lab to be examined by a pathologist.

• Excisional Biopsy: This is the preferred method for suspected melanomas. The doctor removes the entire lesion and a small margin of healthy skin around it.
• Punch Biopsy: A small, circular tool is used to remove a deeper sample of the skin.

3. Sentinel Lymph Node Biopsy: If the melanoma is diagnosed as being thick or having other high-risk features, a surgeon may perform a sentinel lymph node biopsy. This procedure involves injecting a dye near the tumor to find the first lymph node (the "sentinel" node) that drains the area. This lymph node is then removed and checked for cancer cells to see if the melanoma has spread.

4. Imaging Scans: If the melanoma is thick or has spread to the sentinel lymph node, imaging scans may be used to see if the cancer has spread to distant parts of the body.

• CT (Computed Tomography) Scan: A CT scan provides detailed images of the chest, abdomen, and pelvis.
• PET (Positron Emission Tomography) Scan: A PET scan can be very helpful as it can identify active cancer cells throughout the body.
• MRI (Magnetic Resonance Imaging) Scan: An MRI may be used to check for cancer in the brain.

Staging and Grading of Melanoma

Melanoma is staged to help doctors predict the patient's prognosis and choose the best treatment. The stage is based on the size and thickness of the tumor, whether it has spread to nearby lymph nodes, and whether it has spread to distant organs.

Tumor Thickness (Breslow Depth): The most important factor for early-stage melanoma is the thickness of the tumor.

Staging: Melanoma is staged using a four-stage system.

• Stage 0 (In Situ): The cancer is only in the top layer of the skin and has not spread deeper.
• Stage I: The tumor is thin and has not spread.
• Stage II: The tumor is thicker and has a higher risk of recurrence, but has not spread.
• Stage III: The cancer has spread to nearby lymph nodes or has spread in the skin between the original tumor and the lymph nodes.
• Stage IV: The cancer has spread to distant parts of the body, such as the lungs, liver, or brain.

What Are the Treatment Options for Melanoma?

The treatment plan for melanoma is highly personalized and depends on the stage, the tumor's specific characteristics, and the patient's overall health.

1. Surgery

Surgery is the primary treatment for almost all stages of melanoma.

• Wide Local Excision: For early-stage melanoma, the surgeon removes the tumor and a margin of healthy skin around it to ensure all the cancer cells are gone.
• Lymph Node Dissection: If the sentinel lymph node biopsy is positive for cancer, the surgeon may remove all the lymph nodes in that area (lymph node dissection) to remove any remaining cancer cells.
• Metastasectomy: In some cases, if the cancer has spread to a limited number of distant organs, a surgeon may remove these tumors.

2. Medical Treatment (Targeted Therapy and Immunotherapy)

• Immunotherapy: Immunotherapy has revolutionized the treatment of melanoma. These drugs, such as checkpoint inhibitors, help a patient's own immune system recognize and attack cancer cells. Immunotherapy is now the standard of care for many advanced melanomas.
• Targeted Therapy: Targeted therapies are designed to attack specific genetic changes in melanoma cells. For patients with a specific mutation in the BRAF gene, a combination of targeted therapy drugs can be very effective.

3. Radiation Therapy

In special cases, such as melanoma of the eye (ocular melanoma) or when melanoma spreads to the brain, advanced radiation options like proton therapy are available at Apollo Hospitals. Proton therapy allows doctors to deliver radiation more precisely to the tumor while protecting healthy tissue, especially in sensitive areas like the eye or brain. While it is not routinely used for skin melanoma, it can be helpful in these rare, complex situations.

Prognosis and Survival Rates for Melanoma

The prognosis (the likely outcome of the disease) for melanoma has improved dramatically in recent decades due to new treatments. The outlook depends on the stage of the cancer at diagnosis.

Prognostic Factors: The most important factors affecting prognosis are the stage of the cancer, the thickness of the tumor, and whether it has spread to nearby lymph nodes or distant organs.

Survival Rates: The survival rate varies significantly by the stage.

• Localized Melanoma (Stage I and II): The 5-year survival rate is around 99%.
• Regional Melanoma (Stage III): The 5-year survival rate is around 66%.
• Distant Melanoma (Stage IV): The 5-year survival rate is around 22%.

It is important to remember that these numbers are averages and are based on data from several years ago. With the advent of new treatments, the prognosis for advanced melanoma is improving.

Screening and Prevention of Melanoma

There are no routine screening tests for melanoma in the general population. The best way to reduce your risk is to practice sun safety and be aware of your skin.

Prevention Strategies:

• Limit UV Exposure: This is the single most important way to prevent melanoma. Avoid the sun during peak hours (10 a.m. to 4 p.m.), wear sun-protective clothing, a wide-brimmed hat, and sunglasses.
• Use Sunscreen: Use a broad-spectrum sunscreen with an SPF of 30 or higher every day, even on cloudy days.
• Avoid Tanning Beds: The UV rays from tanning beds are just as harmful as the sun's and can significantly increase your risk of melanoma.
• Perform Skin Self-Exams: Regularly check your skin for any new or changing spots, bumps, or moles. Look for any sores that don't heal.

For International Patients: Your Seamless Journey to Apollo Hospitals

Apollo Hospitals is a leading medical destination for international patients seeking high-quality and affordable cancer care. Our dedicated International Patient Services team is here to ensure your entire experience is as smooth and comfortable as possible. We have extensive experience treating patients with complex conditions, including melanoma.

Our Services for International Patients Include:

• Travel and Visa Assistance: We will provide you with a visa invitation letter and help with travel arrangements.
• Airport Transfers: We will arrange for a car to pick you up from the airport.
• Personalized Care: A dedicated patient coordinator will be your single point of contact, assisting with hospital admission, language interpretation, and any other needs you may have.
• Accommodation: We can assist you with booking suitable accommodation for you and your family near the hospital.
• Post-Treatment Follow-up: We will stay in touch with you after your return home to ensure a smooth recovery.

Frequently Asked Questions (FAQs) About Melanoma

Q1: Is melanoma curable?

A: Yes, melanoma is curable, especially when it is found and treated early. The cure rate for early-stage melanoma is very high with proper treatment.

Q2: What is the survival rate for melanoma?

A: The survival rate varies significantly by the stage. For localized melanoma, the 5-year survival rate is around 99%. For metastatic melanoma, the prognosis is not as good, but with new treatments, the prognosis is improving.

Q3: What are the side effects of melanoma treatment?

A: Side effects vary with the type of treatment. Surgical removal can leave a scar. Immunotherapy can cause a range of side effects as the immune system is activated, including fatigue and a rash. Your medical team will work closely with you to manage these side effects.

Q4: Can melanoma come back (recurrence)?

A: Yes, there is a risk of recurrence, especially for thicker melanomas. This is why regular follow-up appointments and monitoring are crucial.

Q5: What is the typical recovery time after melanoma surgery?

A: The recovery time depends on the complexity of the surgery. For a simple wide local excision, recovery may take a few weeks. For a lymph node dissection, recovery can be longer. Your surgeon will provide a detailed recovery plan.

Q6: How is melanoma different from other skin cancers?

A: Melanoma is a much more aggressive and dangerous form of skin cancer than basal cell carcinoma or squamous cell carcinoma. It can spread to other parts of the body if not caught early.

Q7: Is there any way to prevent melanoma?

A: The best way to prevent melanoma is to practice sun safety by avoiding UV exposure, wearing sun-protective clothing, and using sunscreen every day.

Q8: What is the most common cause of melanoma?

A: The most common cause of melanoma is exposure to ultraviolet (UV) radiation from the sun or from tanning beds.

Q9: Who should get screened for melanoma?

A: Everyone should perform regular skin self-exams. People with a high risk of melanoma, such as those with a family history or many moles, should have regular skin checks with a dermatologist.