Melanoma

Q. What is melanoma?
A.  Melanoma, the most serious form of skin cancer, is characterized by the uncontrolled growth of pigment-producing cells. Melanomas may appear on the skin suddenly without warning but also can develop on an existing mole. The overall incidence of melanoma continues to rise. In fact, melanoma rates in the United States doubled from 1982 to 2011.1  

Q.  Is melanoma a serious disease?
A.  Melanoma is highly treatable when detected early, but advanced melanoma can spread to the lymph nodes and internal organs, which can result in death. It is estimated that 9,320 people will die from melanoma in 2018.2-3

Q.  What causes melanoma?
A.  Exposure to natural and artificial ultraviolet light is a risk factor for all types of skin cancer, including melanoma.Research indicates that UV light from the sun and tanning beds can both cause melanoma and increase the risk of a benign mole progressing to melanoma.4

  • People who live close to the equator where the sunlight is more intense are more likely to develop melanoma than those in other regions.5-6
  • People older than 65 may experience melanoma more frequently because of UV exposure they've received over the course of their lives.7
  • Experiencing five or more blistering sunburns between ages 15 and 20 increases one's melanoma risk by 80 percent.8
  • Exposure to tanning beds increases the risk of melanoma, especially in women 45 or younger.9-10

Approximately 95 percent of melanoma cases are attributable to UV exposure.11 Other possible factors include genetics and immune system deficiencies.  

Q.  Who gets melanoma?
A.  Melanoma can strike anyone. In fact, more than 1 million Americans are living with melanoma.12

Caucasians are more likely to be diagnosed with melanoma than other races. Even among Caucasians, however, certain individuals are at higher risk than others.2 For example, men older than 50 have a higher risk of developing melanoma than the general population.2, 13 Your risk is also increased if you:   

  • Have more than 50 moles, large moles or atypical (unusual) moles.2
  • Have a family history of melanoma.2
  • Have sun-sensitive skin (i.e., you sunburn easily, or you have red or blond hair).2
  • Have a history of excessive sun exposure or indoor tanning.2
  • Have had a previous melanoma or nonmelanoma skin cancer, which is more common than melanoma.14-17
  • Have had other previous cancers, such as breast or thyroid cancer.18-21

Skin cancer can affect anyone, regardless of skin color. In patients with skin of color, the disease is often diagnosed in its later stages, when it’s more difficult to treat.22-23 Research has shown that patients with skin of color are less likely than Caucasian patients to survive melanoma.24

Q.  What are atypical moles?
A.  Most people have moles (also known as nevi). Atypical moles are unusual moles that are generally larger than normal moles and variable in color. They often have irregular borders and may occur in far greater number than regular moles. Atypical moles occur most often on the upper back, torso, lower legs, head and neck. It is important to recognize that atypical moles are not limited to any specific body area — they may occur anywhere. The presence of atypical moles is an important risk factor for melanoma developing in a mole or on apparently normal skin.

Q.  What does melanoma look like?
A.  Recognition of changes in the skin is the best way to detect early melanoma. They most frequently appear on the upper back, torso, lower legs, head and neck.15, 25

  • In females 15-29 years old, the torso/trunk is the most common location for developing melanoma, which may be due to high-risk tanning behaviors.13, 22 
  • People with skin of color are prone to skin cancer in areas that aren’t commonly exposed to the sun, like the palms of the hands, the soles of the feet, the groin and the inside of the mouth. They also may develop melanoma under their nails.23

The American Academy of Dermatology urges everyone to examine their skin regularly. This means looking over your entire body, including your back, your scalp, your palms, your soles and between your toes.

If you notice a mole on your skin, you should follow the ABCDE rule, which outlines the warning signs of melanoma:

  • Asymmetry: One half does not match the other half.
  • Border irregularity: The edges are ragged, notched or blurred.
  • Color: The pigmentation is not uniform. Different shades of tan, brown or black are often present. Dashes of red, white, and blue can add to the mottled appearance.
  • Diameter: While melanomas are usually greater than 6mm in diameter when diagnosed, they can be smaller.
  • Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color.

If you notice a new mole, a mole different from others on your skin, or one that changes, itches or bleeds, even if it is smaller than 6mm, you should make an appointment to see a board-certified dermatologist as soon as possible. 

Q.  Can melanoma be cured?
A.
  When detected in its earliest stages, melanoma is highly treatable. The average five-year survival rate for individuals whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent. Five-year survival rates for regional (lymph nodes) and distant (other organs/lymph nodes) stage melanomas are 63 percent and 20 percent, respectively.2 

Early detection is essential. Dermatologists recommend a regular self-examination of the skin to detect changes in its appearance.  Changing, suspicious or unusual moles or blemishes should be examined as soon as possible. A dermatologist can make individual recommendations as to how often a person needs a skin exam from a doctor based on individual risk factors, including skin type, history of sun exposure and family history. Individuals with a history of melanoma should have a full-body exam at least annually and perform monthly self-exams for new and changing moles.26

Q.  Can melanoma be prevented?
A. 
   UV exposure is the most preventable risk factor for all skin cancers, including melanoma. Here’s how to protect your skin from the sun’s harmful UV rays: 

  • Seek shade. Remember that the sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow is shorter than you are, seek shade.
  • Wear protective clothing. This means wearing a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, when possible.
  • Generously apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Broad-spectrum sunscreen provides protection from both UVA and UVB rays.
    • Use sunscreen whenever you are going to be outside, even on cloudy days.
    • Apply enough sunscreen to cover all exposed skin. For more adults, this is about an ounce, or enough to fill a shot glass.
    • Don’t forget to apply to tops of your feet, your neck, your ears and the top of your head.
    • Reapply sunscreen every two hours, or after swimming or sweating.
  • Take care around water, snow, and sand. These reflect and intensify the sun’s damaging rays.
  • Avoid tanning beds. UV light from tanning beds can cause skin cancer and early skin aging.
  • Consider using a self-tanning product if you want to look tan, but continue to use sunscreen with it.
 

Learn more about skin cancer:
Melanoma
Skin cancer detection
Skin cancer prevention
Skin cancer fact sheet

 1Guy GP Jr, Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: melanoma incidence and mortality trends and projections - United States,1982-2030. MMWR Morb Mortal Wkly Rep. 2015 Jun 5;64(21):591-6.

2American Cancer Society. Cancer Facts & Figures 2018. Atlanta: American Cancer Society; 2018.

3Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018; doi: 10.3322/caac.21442.

4Shain, AH et al. The genetic evolution of melanoma from precursor lesions. N Engl J Med 2015; 373: 1926-1936.

5Eide MJ, Weinstock MA. Association of UV index, latitude, and melanoma incidence in nonwhite populations--US Surveillance, Epidemiology, and End Results (SEER) Program, 1992 to 2001. Arch Dermatol. 2005 Apr;141(4):477-81.

6Hu S, Ma F, Collado-Mesa F, Kirsner RS. UV radiation, latitude, and melanoma in US Hispanics and blacks. Arch Dermatol. 2004 Jul;140(7):819-24

7Jemal A, Saraiya M, Patel P, et al. Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992–2006. J Am Acad Dermatol 2011;65:S17.

8Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev; 2014. 23(6); 1080-1089.

 9Ting W, Schultz K, Cac NN, Peterson M, Walling HW. Tanning bed exposure increases the risk of malignant melanoma. Int J Dermatol. 2007 Dec;46(12):1253-7.

10Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014;70:847–57.

11Islami F et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. Published online Nov. 21, 2017. doi: 10.3322/caac.21440.

12SEER Cancer Stat Facts: Melanoma of the Skin. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/melan.html

13Little EG, Eide MJ. Update on the current state of melanoma incidence. Dermatol Clin. 2012:30(3):355-61.

14 Bower CP, Lear JT, Bygrave S, Etherington D, Harvey I, Archer CB. Basal cell carcinoma and risk of subsequent malignancies:  a cancer registry-based study in southwest England.  J Am Acad Dermatol 2000;42:988-91.

15 World Health Organization, Solar ultraviolet radiation:  Global burden of disease from solar ultraviolet radiation. Environmental Burden of Disease Series, N.13. 2006.

16 Hemminki K, Dong C. Subsequent cancers after in situ and invasive squamous cell carcinoma of the skin.  Arch Dermatol 2000;136:647-51.

17 Rosenberg CA, Greenland P, Khandekar J, Loar A, Ascensao J, Lopez AM. Association of nonmelanoma skin cancer with second malignancy. Cancer 2004;49:81-5.  

18 Grenader T, Goldberg A, Shavit L. Second cancers in patients with male breast cancer: a literature review. J Cancer Surviv. 2008;2(2):73-78.

19 Satram-Hoang S, Ziogas A, Anton-Culver H. Risk of second primary cancer in men with breast cancer. Breast Cancer Res. 2007;9(1):R10.

 20 Auvinen A, Curtis R, Ron E.  Risk of subsequent cancer following breast cancer in men. J Natl Cancer Inst. 2002;94(17):1330-1332.

 21 Canchola A, Horn-Ross P, Purdie D. Risk of secondary primary malignancies in women with papillary thyroid cancer. Am J Epidemiol. 2006;163(6):521-527.

22 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015.

23 Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.

24 Dawes SM et al. Racial disparities in melanoma survival. J Am Acad Dermatol. 2016 Nov; 75(5):983-991.

25 Cancer Epidemiology in Older Adolescents & Young Adults. SEER AYA Monograph Pages 53-57.2007. 

26 Berg, A. US Preventive Services Task Force. Screening for skin cancer. http://archive.ahrq.gov/clinic/ajpmsuppl/skcarr.htm