Melanoma is caused by changes in skin cells called melanocytes. These cells make a skin color pigment called melanin. Melanin is responsible for skin and hair color.

Melanoma can appear on normal skin. Or, it can begin as a mole or other area that then changes in appearance. Some moles that are present at birth may develop into melanomas. Larger moles that are present at birth are at higher risk of developing melanoma.

There are four major types of melanoma:

  • Superficial spreading melanoma is the most common type. It is usually flat and irregular in shape and color, with different shades of black and brown. It is most common in Caucasians.
  • Nodular melanoma usually starts as a raised area that is dark blackish-blue or bluish-red. Some do not have any color (amelanotic melanoma).
  • Lentigo maligna melanoma usually occurs in older people. It is most common in sun-damaged skin on the face, neck, and arms. The abnormal skin areas are usually large, flat, and tan with areas of brown.
  • Acral lentiginous melanoma is the least common form. It usually occurs on the palms, soles, or under the nails. It is more common in African Americans.

In rare cases, melanomas appear in the mouth, iris of the eye, or retina at the back of the eye. These may be found during dental or eye exams. In very rare cases, a melanoma develops in the vagina, esophagus, anus, urinary tract or small intestine.

Melanoma is not as common as other types of skin cancer, such as basal cell carcinoma. But more and more people are developing melanoma, especially young adults.

Melanoma Symptoms

A mole, sore, lump, or growth on the skin can be a sign of melanoma or other skin cancer. A sore or growth that bleeds, or changes in color can also be a sign of skin cancer.

The ABCDE system can help you remember possible symptoms of melanoma:

  • Asymmetry: One half of the abnormal area is different from the other half.
  • Borders: The edges of the growth are irregular.
  • Color: Color changes from one area to another, with shades of tan, brown, or black, and sometimes white, red, or blue. A mixture of colors may appear within one sore.
  • Diameter: The spot is usually (but not always) larger than 6 mm in diameter -- about the size of a pencil eraser.
  • Evolution: The mole keeps changing appearance.

Who Is Most At Risk?

The risk of developing melanoma increases with age, though the risk is rising in young people.

  • You are more likely to develop melanoma if you:
  • Have fair skin, blue or green eyes, or red or blond hair
  • Live in sunny climates or at high altitudes
  • Spent a lot of time in high levels of strong sunlight because of a job or other activities
  • Have had one or more blistering sunburns during childhood
  • Use tanning devices

Other risk factors include:

  • Having close relatives with melanoma
  • Certain types of moles (atypical or dysplastic) or many birthmarks
  • Weakened immune system due to disease or medicines

Melanoma Diagnosis

Your doctor will check your skin and look at the size, shape, color, and texture of any suspicious areas.

If your doctor thinks you might have skin cancer, a piece of skin from the growth will be removed. This is called a skin biopsy. The sample is sent to a lab for examination under a microscope.

A sentinel lymph node (SLN) biopsy may be done in some people with melanoma to see if the cancer has spread to nearby lymph nodes.

Once melanoma has been diagnosed, CT scans or other types of x-rays may be done to see if the cancer has spread.

Multidisciplinary Approach to Melanoma Treatment

At Wake Forest Baptist, a team of cancer specialists will work together with you to provide the most advanced personalized treatment available.

Because of our multidisciplinary approach to treatment for all cancers, Wake Forest Baptist has been designated by the National Cancer Institute as a Comprehensive Cancer Center, one of only 41 in the country.

There are several treatment options for melanoma:

  • Surgery. Your doctor will probably recommend surgery as your first form of treatment if you have melanoma. Your surgeon will recommend a wide local excision to remove the melanoma lesion as well as surrounding tissue to try to prevent the cancer from spreading. Wake Forest Baptist surgical oncologists use sentinel lymph node biopsies during surgery to determine if the cancer has spread to lymph nodes. Once involved lymph nodes are identified, they can safely remove them. Surgery is also used to stage the cancer—to determine how far the cancer has spread.
  • Immunotherapies. There are many exciting advancements in the use of immunotherapies to treat melanoma. These include a new approach known as immune checkpoint blockade, drugs known as cytokines and cell transfer techniques.
  • Targeted therapies. Genetic changes (mutations) have been identified in melanoma tumors that promote its growth. About half of all melanomas have changes n the BRAF gene. Your tumor can be tested to see if it expresses these mutations. Several new drugs are being used to target melanoma tumors that have mutations in the BRAF gene, including vemurafenib (Zelboraf), dabrafenib (Tafinlar), trametinib (Mekinist), and cobetinib (Cotellic). Clinical trials are in progress to test different genetic targets and drugs.
  • Radiation Therapy can be effective for patients with advanced cases of melanoma. Radiation therapy can help treat the spread of the disease.
  • Chemotherapy can be an effective treatment for melanoma, depending on the stage of the disease. At Wake Forest Baptist, our physicians perform an unusual chemotherapy technique known as perfusion/infusion.