Melanoma: Frequently Asked Questions

Here are answers to some frequently asked questions about melanoma.

What is the skin?

The skin is the body's biggest organ. It keeps water and other fluids in the body. It also keeps out germs and other foreign substances. The skin has 3 layers:

• Epidermis. This 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. This is the middle layer.

• Subcutis. This is the innermost layer.

What is melanoma?

Melanoma is a type of skin cancer that starts in skin cells called melanocytes. These cells give the skin its tan or brown color. It’s thought to start when normal melanocytes become cancerous. Melanoma can often be cured when found early. But if not treated, it can spread quickly to organs such as the liver, lungs, bones, and brain. It can spread anywhere in the body.

What are some of the risk factors for melanoma?

Many melanomas are caused by too much sun exposure. The more time you spend in the sun, the higher your chance of getting this type of cancer. Especially if you spent much time in the sun as a child. You are also at greater risk if you have:

• Had severe blistering sunburns, especially as a child

• Fair skin

• Many moles or with atypical moles (dysplastic nevi)

• A family history of melanoma

• Had melanoma or another type of skin cancer before

Where on the body do people usually get melanoma?

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 or 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.

Melanomas also tend to appear in areas that get a lot of sun exposure, such as the head and neck. But sometimes melanoma may occur on areas that are rarely 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 genital area, in the eyes, or other organs.

Can I prevent melanoma?

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 2 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.

What are atypical moles or dysplastic nevi?

Some moles don’t look the same as normal or typical moles. These 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.

Can melanoma be found early?

Everyone should check their skin often for any new, strange or changing moles or other lesions. If you have more than 50 moles or have been told you have atypical or dysplastic moles, see a dermatologist regularly to have your skin checked.

About 10% of people with melanoma have family members with it. If you have close relatives who have had melanoma, you have a higher chance of getting it. Have your skin checked by a doctor more often. And, take extra care to avoid the sun.

What are the signs of a melanoma?

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. This means that the 2 halves of the mole do not look the same.

• Border. The border or edge of a mole that is a melanoma is sometimes blurred and ragged.

• Color. 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.

• Diameter. 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.

Doctors often add an E to the ABCD rule, which stands for evolving. Any mole that is changing in size, shape, color, or in how it feels should be checked by a doctor. 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 with a doctor right away if you notice any changes in moles.

What should I do if I find a new or strange-looking mole?

Any new or strange-looking moles should be shown to a doctor as soon as possible. The doctor might refer you to a dermatologist. This doctor is an expert 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. He or she checks it under the microscope for cancer cells.

Should everyone get a second opinion for a diagnosis of melanoma?

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.

How can I get a second opinion?

There are many ways to get a second opinion.

• Ask your primary care doctor. He or she may be able to suggest a specialist. This may be a dermatologist, 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.

How is melanoma treated?

Surgery is the most common treatment. If it's done in the early stages, 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 might also be part of treatment, especially when a person can't have surgery.

What is a skin graft?

For a skin graft, skin from another part of the body is used to replace skin that was removed during surgery. This is typically only needed if a large area of skin needs to be removed. The skin graft is usually taken from the back or thigh. The surgeon stitches it to the area where the melanoma was removed.

How often should I see my doctor?

If you’ve had melanoma, see your doctor regularly for the rest of your life. The risk of getting it again (or getting another type of skin cancer) is much higher than in those who haven't had it.

Many doctors recommend that people with melanoma 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.

What are clinical trials?

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 take part in these studies often 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.