Risk Factors

Several factors influence the risk of developing melanoma:

• Sunburns: Chances of developing melanoma are higher if you had at least one blistering sunburn before the age of 18.
• Sun exposure: Ultraviolet (UV) rays from the sun can damage the skin and cause precancerous changes in melanocytes over time. To reduce your risk of melanoma, while outdoors wear a wide-brimmed hat and sunglasses, seek shade, and apply broad-spectrum sunblock with SPF 30 or higher. Also limit time in the sun between 10 a.m. and 4 p.m. when the sun's rays are most direct.
• Tanning beds: Because tanning beds use UV rays, they cause damage to the skin just as sun exposure does.
• Fair complexion: Chances of developing melanoma are higher if a person has light skin, freckles, green or blue eyes, and red or blond hair.
• Family health history: Chances of developing melanoma are higher if a person has a mother, father, or sibling who had melanoma. Learn more about hereditary cancer risk from our Family Cancer Assessment Clinic.
• Many moles or freckles: A person with lots of moles and freckles on their skin should have regular clinical skin exams to check for signs of precancerous changes.

Symptoms

Huntsman Cancer Institute (HCI) recommends regular skin exams to get familiar with individual patterns of moles and freckles, and to look for symptoms of cancerous changes.

The ABCDE's of melanoma can help identify an abnormal mole:

• Asymmetry – one half of a mole appears different than the other half
• Border – the border of a mole appears jagged or irregular
• Color – the color of a mole appears different than the normal brown of a healthy mole
• Diameter – the mole is larger than the size of a pencil eraser
• Evolution – the mole changes over time in any of the above characteristics, or a new mole develops with any of the above characteristics

If you notice any of these changes or abnormalities, visit your dermatologist as soon as possible.

Learn about HCI's annual free skin cancer screening by calling the Cancer Learning Center at 1-888-424-2100.

Screening and Diagnosis

Screening tests for melanoma include the following:

• A monthly skin self-exam:
  1. Examine your body from all sides in front of a mirror. Bend your elbows and look carefully at the forearms, upper arms, and palms.
  2. Look at the backs of your legs and feet, the soles, and spaces between the toes.
  3. Examine the back of your neck and scalp with a hand mirror, parting and lifting the hair. Also, check your back, buttocks, and genital area.
• A yearly skin exam by a dermatologist. Learn about HCI's annual free skin cancer screening by calling the Cancer Learning Center at 1-888-424-2100.
• Mole mapping involves taking pictures of moles for magnification and for comparison of how they change over time. This is often used when a person has many moles or moles that apprea abnormal.

People with a family history of melanoma may need to follow a different screening schedule based on recommendations from a health care provider.

Diagnosis

If an abnormal mole is found, removing the mole and a portion of surrounding skin (called an excisional biopsy) is the only way to find out if cancer is present and if it has started to spread.

If cancer is detected in a biopsy, a sentinel lymph node biopsy may be used to help determine the stage (extent) of the disease. A sentinel lymph node is the first lymph node to which cancer cells are likely to spread from the tumor. This procedure takes a sample from the sentinel lymph node to check for cancer cells.

Staging

If cancer is detected in a biopsy, a sentinel lymph node biopsy may be used to help determine the stage (extent) of the disease. A sentinel lymph node is the first lymph node to which cancer cells are likely to spread from the tumor. This procedure takes a sample from the sentinel lymph node to check for cancer cells.

Stages of Melanoma

Stage 0 (in situ):

• The cancer cells are only in the very top layers of the skin (called the epidermis)
• Cancer cells have not spread to lymph nodes or other areas of the body

Stage Ia:

• The tumor is no more than 1 mm thick.
• Cancer cells have not spread to lymph nodes or other areas of the body.

Stage Ib:

• The tumor is 1-2 mm thick.
• The tumor is less than 1 mm thick with ulceration (the upper layers appear broken when examined under a microscope).

Stage IIa:

• The tumor is between 2-4 mm thick with no ulceration.
• The tumor is between 1-2 mm thick with ulceration (the upper layers appear broken when examined under a microscope).
• Cancer cells have not spread to nearby lymph nodes or other areas of the body

Stage IIb:

• Tumor is 4 mm thick or larger with no ulceration.
• Tumor is between 2-4 mm thick with ulceration (the upper layers appear broken when examined under a microscope).
• Cancer cells have not spread to nearby lymph nodes or other areas of the body.

Stage IIc:

• The tumor is larger than 4 mm thick with ulceration (the upper layers appear broken when examined under a microscope).
• Cancer cells have not spread to nearby lymph nodes or other areas of the body.

Stage III:

• Cancer cells have spread to nearby lymph nodes but not to distant areas of the body
• Stage III is diagnosed based on the following:
  • The number of lymph nodes with cancer cells
  • If cancer cells are detected only with a microscope (called micrometastases) or if they can be seen and felt (called macrometastases)
  • Ulceration (the upper layers appear broken when examined under a microscope).

Stage IV:

• Cancer cells have spread from the original site to lymph nodes and other areas of the body

Treatment

At Huntsman Cancer Institute, melanoma is treated by a team of specialists, including dermatologists (doctors who specialize in diseases of the skin), medical oncologists, nurses, social workers, dietitians, and other professionals.

Melanoma treatment options include:

• Surgery
• Immunotherapy
• Radiation therapy
• Chemotherapy
• Clinical trials

The treatments used depend on the stage of the disease and the person's general health and medical history. Learn more in our factsheets by stage of melanoma.

Surgery

This treatment removes the cancerous area along with a rim of healthy skin around it (called an excision). This helps a doctor know if the cancer has started to spread.

In some cases, surgery is used to remove lymph nodes that either contain cancer or to prevent the cancer from spreading through the lymphatic system (called a therapeutic lymph node dissection).

Immunotherapy

This treatment works with the body's immune system to fight melanoma. Interferon and Interleukin are examples of immunotherapy used to treat melanoma stages III and IV.

Radiation therapy

This treatment uses high-energy rays to kill cancer cells and shrink tumors.

Chemotherapy

This treatment uses drugs that enter the bloodstream and destroy or control cancer throughout the body. Learn more about this treatment in our introduction to chemotherapy video.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.