Cutaneous Melanoma
Cutaneous melanoma is the most common form of melanoma. It originates in cells called melanocytes, which produce melanin, the pigment responsible for giving color to our skin, hair, and eyes. It is the most aggressive form of skin cancer and can spread to other parts of the body if not detected and treated early.
Cutaneous melanoma typically develops on areas of the skin that have been exposed to the sun, but it can also occur in areas that are not regularly exposed to sunlight. It can appear as a new mole or arise from an existing mole or skin growth. Melanoma can occur in people of all skin tones, although it is more common in individuals with fair skin.
What are the signs and symptoms of cutaneous melanoma?
The signs and symptoms of cutaneous melanoma can vary, but the most common signs and symptoms are called the ABCDE’s of Melanoma:
- Asymmetrical Moles: Melanoma often appears as a mole or growth on the skin that is asymmetrical, meaning one half does not match the other half.
- Borders that are Irregular: Melanoma lesions may have uneven or irregular borders, with edges that are not smooth or well-defined.
- Colors that Change: Melanoma can have a variety of colors within the same lesion, including shades of brown, black, blue, red, or white.
- Diameter of 6mm or More: Melanoma lesions are typically larger in diameter than a pencil eraser (about 6 millimeters or more), but they can also be smaller.
- Evolving Appearance: Pay attention to any mole or growth that changes in size, shape, color, or elevation, or starts to bleed, itch, or become painful.
It's important to note that not all melanomas follow these specific characteristics, and some may not exhibit any symptoms at all. Regular self-examinations of your skin and routine check-ups with a dermatologist are crucial for early detection and treatment. If you notice any concerning changes on your skin, it's best to consult a healthcare professional for a proper evaluation.
How common is cutaneous melanoma?
Cutaneous melanoma is the most common form of melanoma and the fifth most common cancer diagnosed in the United States. In 2023, an estimated 97,610 people in the United States are expected to be diagnosed with melanoma. The rate of new cases of melanoma has more than doubled in the last 30 years.
How serious is cutaneous melanoma?
Cutaneous melanoma can be a serious and potentially life-threatening form of skin cancer if not detected and treated early. The seriousness of cutaneous melanoma depends on various factors, including the stage of the cancer at diagnosis, the thickness and depth of the tumor, and whether it has spread to nearby lymph nodes or other parts of the body.
Melanoma has the potential to metastasize (spread) to other organs, such as the lungs, liver, brain, or bones. Once it spreads, it becomes more difficult to treat.
However, it's important to note that early detection and treatment significantly improve the chances of successful outcomes. When melanoma is diagnosed at an early stage, before it has spread, the five-year survival rate is very high.
Who gets cutaneous melanoma?
Cutaneous melanoma can affect people of all ages and ethnicities, but certain factors increase the risk of developing this type of skin cancer. Here are some factors that contribute to the development of cutaneous melanoma:
- Sun exposure: An estimated 90% of melanomas are caused by excessive exposure to ultraviolet (UV) radiation from the sun or tanning beds. People who spend a lot of time in the sun without protection are at higher risk. Studies show that having 5 or more blistering sunburns between the ages of 15-20 increases your risk of getting melanoma by 80%.1
- Fair skin: Individuals with fair skin, light hair, and light-colored eyes have less melanin, which provides some natural protection against UV radiation. As a result, they are more susceptible to the harmful effects of the sun and have a higher risk of developing melanoma and other skin cancers.
- Family history: Having a close relative (parent, sibling, or child) with a history of melanoma increases the risk of developing the disease. For most families, even those with multiple members who have developed melanoma, it’s their shared history of sun exposure, such as regular trips to the beach, that put them at increased risk. However, certain inherited genetic mutations, such as mutations in the CDKN2A or CDK4 genes, can also contribute to familial melanoma.
- Personal history: Individuals who have previously had melanoma or other types of skin cancer are at an increased risk of developing additional melanomas.
- Age: The risk of melanoma increases with age, with the majority of cases occurring in individuals over the age of 50. However, melanoma can also affect younger individuals, especially in cases of excessive sun exposure or genetic predisposition.
- Weakened immune system: People with a weakened immune system such as those who have undergone organ transplantation, have a higher risk of developing cutaneous melanoma.
It's important to note that while these factors can increase the risk of developing cutaneous melanoma, anyone can develop this type of skin cancer.
What causes cutaneous melanoma?
Melanoma forms when something goes wrong in the pigment producing-cells called melanocytes that give your skin color. When the DNA in these cells become damaged, they may begin to grow out of control.
Experts believe that approximately 90% of cutaneous melanomas are caused by ultraviolet radiation from the sun or indoor tanning devices. They can tell that by measuring the type and amount of DNA damage in many melanoma tumor samples.
How is cutaneous melanoma treated?
The treatment of cutaneous melanoma depends on various factors, including the stage of the cancer, the location and size of the tumor, and the individual's overall health. The primary treatment options for cutaneous melanoma include:
- Surgery: Surgery is the mainstay of treatment for localized melanoma. The goal is to remove the tumor along with a margin of healthy tissue. The extent of surgery will depend on the thickness and depth of the melanoma.
- Immunotherapy: Immunotherapy uses medications to stimulate the body's immune system to recognize and attack cancer cells. Checkpoint immunotherapies are typically the first-line treatment for patients with metastatic melanoma (also called advanced melanoma).
- Targeted therapy: Targeted therapy involves using drugs that specifically target genomic mutations or proteins present in melanoma cells. Examples of targeted therapy drugs include BRAF inhibitors (e.g., vemurafenib, dabrafenib) and MEK inhibitors (e.g., trametinib). These drugs are used in cases where the melanoma has specific genomic mutations, such as BRAF.
- Clinical trials: Clinical trials are research studies that test new treatments or treatment combinations to evaluate their safety and effectiveness. Participating in a clinical trial may provide access to innovative therapies that are not yet widely available.
In addition to these treatment strategies, patients may also receive radiation or chemotherapy in select situations.
Melanoma treatment plans are highly individualized, and your specific treatment plan will depend on the unique characteristics of your melanoma. The treatment team, which may include dermatologists, surgical oncologists, medical oncologists, and radiation oncologists, will work together to determine the most appropriate treatment strategy for you.
Types of cutaneous melanoma:
Superficial Spreading Melanoma
Superficial spreading melanoma is the most common type of cutaneous melanoma. It will slowly grow horizontally across the outermost layer of skin before beginning to invade into deeper layers of the skin.
Nodular Melanoma
Nodular melanoma is the second most common type of cutaneous melanoma. It is also the most aggressive form of melanoma. Nodular melanoma can quickly invade the deepest layers of the skin. Nodular melanoma generally looks like a quickly growing blue or black lump on the skin.
Lentigo Maligna and Lentigo Maligna Melanoma
Lentigo maligna, sometimes referred to as melanoma in situ – or stage 0 melanoma, is the most treatable form of melanoma. When it begins to invade further into the skin, it becomes the much more serious lentigo maligna melanoma. Both look like flat, or slightly raised, brown patches on the skin. They can be easily confused for age spots.
Amelanotic Melanoma
Amelanotic melanoma does not look like other types of melanoma. Instead of dark or even black spots on the body, amelanotic melanoma presents as a faint pinkish-looking mark on the skin. Because of this, amelanotic melanoma can be harder to detect.
Photos of Cutaneous Melanoma:
Lentigo Maligna Melanoma on Brow
Lentigo Maligna Melanoma on Lip
Nodular Melanoma
Nodular Melanoma
Nodular Melanoma
Nodular Melanoma
Amelanotic Melanoma
Photo Credit: CDC/ Carl Washington, M.D., Emory Univ. School of Medicine; Mona Saraiya, MD, MPH