Frequently Asked Questions About Melanoma

Melanoma is the most serious form of skin cancer. It can spread quickly to other organs. Here are answers to some frequently asked questions about melanoma.

What is the skin?

The skin is your body's biggest organ. It keeps water and other fluids in your body. It also keeps out germs and other foreign substances. Your skin has three layers.  

What are the kinds of skin cancer?

There are three main types: basal, squamous and melanoma. The first two are the most common. Although squamous skin cancers can also spread, melanoma is most likely to spread.

What is melanoma?

Melanoma is a type of cancer that starts in skin cells called melanocytes in the top layer of your skin, the epidermis. These cells give your skin its color.  

Melanoma can develop within a mole that you have had for a long time or appear suddenly as a new dark spot. It can spread anywhere in your body.

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What are some of the risk factors of melanoma?

The more time you spend in the sun, especially as a child, the higher your chance of getting melanoma. You are also at greater risk if you have:

• Had severe blistering sunburns, especially as a child
• Fair skin
• Many moles or atypical moles (dysplastic nevi)
• A family history of melanoma
• Had melanoma before

 Where on the body do people usually get melanoma?

Melanoma can occur anywhere on your skin. Men usually get melanoma on the front and back part of their 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 that are rarely exposed to sunlight, including your groin, armpits, soles of the feet, mouth, or sinuses. Another unusual place for melanoma is under the nail beds of your fingers and toes. Less often, melanoma can occur in your genital area, eyes, or other organs.

Can I prevent melanoma?

The best way to protect yourself from melanoma is to avoid getting a lot of sun. Protect yourself when you go outside.

• 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 or at a high elevation.
• 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 provide the best sun protection. They may have an SPF number. Special sun-protective clothing is now available as well. Use beach umbrellas and check their labels for an SPF number.
• Wear sunglasses with UV protection.
• Stay away from tanning salons.

What are atypical moles or dysplastic nevi?

These moles do not need to be removed, as they rarely turn into melanoma. Your risk of melanoma, however, is about 10 times greater if you have five of these moles compared to none.

The moles tend to be bigger than usual, typically flat, with an irregular edge. They may be a mix of colors from pink to dark brown. Tell your doctor if you see any changes in your moles. You can see photos here.

Can melanoma be found early?

Everyone should check their skin often for any new, strange, or changing moles or other lesions.

About 10 percent of people with melanoma have family members with it. If close relatives have had melanoma, you have a higher chance of getting it. See a dermatologist regularly 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 means that the two halves of the mole do not look the same.
• The border or edges of a melanoma mole is sometimes blurred and ragged.
• The color of a melanoma is sometimes uneven. The color 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.

Doctors often add an "E" to the ABCD rule, which stands for evolving. A doctor should examine any mole that is changing in size, shape, color, or texture. 

Melanomas can look very different from each other. Some might have all of the ABCD changes, while some may have few or none. It is important to talk to a doctor right away if you notice any changes in moles. You might ask a friend or partner to look at your back to examine for moles you can’t see.

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

Show any new or strange-looking moles to a doctor, ideally a dermatologist, as soon as possible.

Your doctor will remove a suspect mole during a biopsy and examine it under a 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. Reasons for a second opinion include:

• You don’t feel comfortable with treatment recommendations.
• You are diagnosed with a rare type of cancer.
• You have several treatment options.
• You are not 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 your diagnosis and treatment options before starting treatment.

In most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require you to seek a second opinion. Many other companies will pay for a second opinion. Talk to your insurance provider to make sure.

How can I get a second opinion?

There are many ways to get a second opinion.

• Ask your primary care doctor to suggest a specialist. You could see 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). The service has information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
• Check with a local medical society, a nearby hospital or medical school, or a support group for names of doctors who can provide a second opinion. You can also ask other people who've had cancer for their recommendations.

How is melanoma treated?

Surgery is the most common treatment. Your chances of being cured are higher if you have surgery during the early stages.

During surgery, the doctor removes the cancer and normal cells around it. This is called an excision. 

You may also have chemotherapy, immunotherapy, or targeted therapy if the cancer has spread to other parts of your body.

Radiation is generally used only to treat symptoms when you can't have surgery or chemotherapy.

What is a skin graft?

Skin from another part of your body is used to replace skin that was removed during surgery. The skin is usually taken from your 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 dermatologist regularly for the rest of your life. The risk of getting the cancer again (or getting another skin cancer) is much higher than in people 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, you can see your 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 current treatments.

People who participate in these studies get to use treatments before the Food and Drug Administration approves them for the public. People who join clinical trials also help researchers learn more about cancer and help future cancer patients.

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