Here are answers to some frequently asked questions about melanoma.
Q: What is the skin?
A: The skin is the body's biggest organ. It keeps water and other fluids in the body. And it keeps out germs and other foreign substances. The skin has these three layers.
Epidermis is the top layer. It is very thin and protects the body from things such as germs that could get inside and cause harm. Melanoma forms in skin cells, called melanocytes, which are in this layer.
Dermis is the middle layer.
Subcutis is the innermost layer.
Q: What is melanoma?
A: Melanoma is a type of skin cancer that starts in skin cells called melanocytes, which give the skin its tan or brown color. It is thought to start when normal melanocytes become cancerous. Melanoma can spread quickly to the liver, lungs, bones, and brain. It has the potential to spread anywhere in the body.
Q: What are some of the risk factors for melanoma?
A: Many melanomas are attributed to excess exposure to sunlight. The more time people spend in the sun, especially during youth, the higher their chance of getting this type of cancer. People who have had a severe blistering sunburn—especially as a child—have a higher risk of getting melanoma. People with fair skin get skin cancer more often. There also seems to be a hereditary form of melanoma. It is not very common, though.
Q: Where on the body do people usually get melanoma?
A: Melanoma can occur anywhere on the skin. When it's on the skin, it's called cutaneous melanoma. Men usually get it on the front and back part of the body between the shoulders and the hips, called the trunk. They may also get it on their head or neck. Women most commonly get melanoma on their legs. Sometimes, melanoma may occur on areas of the skin that never are exposed to sunlight, such as the soles of the feet, mouth, or sinuses. Another unusual place for melanoma is under the nail beds of fingers and toes. Less often, melanoma can occur in the mouth or genital area, in the eyes, or other organs.
Q: Is melanoma preventable?
A: There is no sure way to prevent melanoma. The best way to protect yourself from melanoma is to avoid getting a lot of sun. When going outside, everyone should use these tips to protect themselves.
Apply a broad-spectrum sunscreen of SPF (sun protection factor) 30 or higher. Coat yourself with sunscreen 15 minutes before going outside. Reapply at least once every two hours.
Seek shade when the sun is strongest, between 10 a.m. and 4 p.m. This is especially important if you live in an area of high sun intensity.
If you're going to be in the sun, wear long-sleeved shirts, long pants, and a wide-brimmed hat. Fabrics with a tight weave give the best sun protection. Special sun-protective clothing is now available as well.
Wear sunglasses with UV protection.
Q: What are atypical moles or dysplastic nevi?
A: Some moles do not look the same as normal or typical moles and are more likely to become a melanoma. These abnormal moles are sometimes called dysplastic nevi. The cells in these moles are abnormal but are not yet cancerous. People may have just a few atypical moles or they may have many.
Q: Can melanoma be found early?
A: Everyone should check their skin often for any strange or changing moles or other lesions. People who have more than 50 moles or who have been told they have atypical or dysplastic moles should see a dermatologist regularly to have their skin checked.
About 10 percent of people with melanoma have family members with it. A person whose close relatives have had melanoma has a higher chance of getting it. People with a family history of melanoma need to have their skin checked by a doctor more often. They also need to take extra care to avoid the sun.
Q: What are the signs of a melanoma?
A: The first sign of melanoma may be a new mole or one that changes in size, shape, or color. The ABCD traits that may suggest a melanoma are asymmetry, border, color, and diameter.
Asymmetry means that the two halves of the mole do not look the same.
The border or edges of a mole that is a melanoma is sometimes blurred and ragged.
The color of a melanoma is sometimes uneven. The color of a melanoma may be different shades of black, brown, pink, white, red, or blue.
The diameter is the measurement across a melanoma from one side to the other side. If a mole is melanoma, it may get bigger. Melanomas are usually larger than the eraser of a pencil.
Melanomas can look very different from each other. Some might have all of the ABCD changes and some may have few or none. It is important to talk to a doctor right away if you notice any changes in moles.
Q: What should a person do when they find a new or strange-looking mole?
A: Any new or strange-looking moles should be shown to a doctor as soon as possible. The doctor might make a referral to a dermatologist. This doctor specializes in skin problems, including skin cancers. If the doctor suspects cancer, he or she may remove the mole in a biopsy. The doctor sends the removed mole to a specialist called a pathologist, who checks it under the microscope for cancer cells.
Q: Should everyone get a second opinion for a diagnosis of melanoma?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get one. Here are some of those reasons.
Not feeling comfortable with the treatment decision
Being diagnosed with a rare type of cancer
Having several options for how to treat the cancer
Not being able to see a cancer expert
Many people have a hard time deciding which melanoma treatment to have. It may help to have a second doctor review the diagnosis and treatment options before starting treatment. It is important to remember that in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Many other companies will pay for a second opinion if asked.
Q: How can someone get a second opinion?
A: There are many ways to get a second opinion.
Ask a primary care doctor. He or she may be able to suggest a specialist. This may be a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
Seek other options. Check with a local medical society, a nearby hospital or medical school, or a support group to get names of doctors who can give a second opinion. Or ask other people who've had cancer for their recommendations.
Q: How is melanoma treated?
A: Surgery is the most common treatment. If it's done in the early stages, meaning before the cancer has spread, there is a high chance that it can lead to a cure. During surgery, the doctor removes the cancer and normal cells around it. This is called an excision. Chemotherapy, immunotherapy, or targeted therapy may also be used if it has spread to other parts of the body. Radiation is generally only used to treat symptoms when a person can't have surgery or chemotherapy.
Q: What is a skin graft?
A: Skin from another part of the body is used to replace skin that was removed during surgery. The skin is usually taken from the back or thigh. The surgeon stitches it to the area where the melanoma was removed.
Q: How often should a person who's had melanoma see his or her doctor?
A: People who have had melanoma should see their doctor regularly for the rest of their lives. Their risk of getting it again is much higher than those who haven't had it.
Many doctors recommend that people with this type of cancer see their doctor every few months for the first few years after the diagnosis. If there is no evidence that the melanoma has come back after a few years, then they can see the doctor once a year.
Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who participate in these studies get to use treatments before the FDA approves them for the public. People who join trials also help researchers learn more about cancer and help future cancer patients.