Melanoma–Signs, Symptoms, Diagnosis and Treatment

Melanoma can be cured if it is diagnosed and treated when the tumour is thin and has not deeply invaded the skin. However, if a melanoma is not removed at its early stages, cancer cells may grow downward from the skin surface and invade healthy tissue. When a melanoma becomes thick and deep, the disease often spreads to other parts of the body and is difficult to control.  For that reason melanoma should be diagnosed and removed at its early stages.  Generally melanoma and other types of skin cancer can be easily diagnosed from an experienced dermatologist.  The experience of the doctor is vital because he is the only one who can detect rare cases of melanoma like the one that tends to occur under the fingernails or toenails, or on the palms or soles.

Often, the first sign of melanoma is a change in the size, shape, colour, or feel of an existing mole. Most melanomas have a black or blue-black area. Melanoma also may appear as a new mole. It may be black, abnormal, or "ugly looking."  People should regularly check their own skin for new growths or other changes. Changes in the skin, such as a change in a mole, should be reported to a dermatologist, a doctor who specializes in diseases of the skin.  Do not try to diagnose it yourself, because your examination cannot substitute a professional doctor's examination.


How is melanoma diagnosed?


The dermatologist may check the skin by using one of the following methods:
• Simple skin examination 
• Use of a special lamp that highlights all the tiny details of the moles
• Use of digital photography and analysis of the results in the computer (This method can be applied only in specialized centres having high definition cameras which allow the photography of the moles at a specific moment and comparison of these pictures with the pictures taken in a time period after, allowing the detection of any change to these moles). 

If the doctor suspects that a spot on the skin is melanoma, the patient will need to have a biopsy. A biopsy is the only way to make a definite diagnosis.  Especially for the diagnosis of melanoma the thinking of "ABCDE" can help you remember what to watch for:

  Asymmetry - Usually a healthy mole is round and symmetrical. If it is found that the shape of one half does not match the other then this asymmetry is a factor of malignance.

Border - Usually a healthy mole has a geometrical outline –the edges are often ragged, notched, blurred, or irregular in outline; the pigment may spread into the surrounding skin.

Color - Usually a healthy mole has a unique colour. In case of malignance the colour is uneven. Shades of black, brown, and tan may be present. Areas of white, grey, red, pink, or blue also may be seen.

Diameter - There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (6 millimeters).

Evolution - Melanomas can vary greatly in how they look. Many show all of the ABCD features. However, some may show changes or abnormalities in only one or two of the ABCD features.  In any case we have to visit immediately a dermatologist.

Melanomas in an early stage may be found when an existing mole changes slightly, for example, when a new black area forms. Newly formed fine scales and itching in a mole are also common symptoms of early melanoma. In more advanced melanoma, the texture of the mole may change. For example, it may become hard or lumpy. Melanomas may feel different from regular moles. More advanced tumours may itch, ooze, or bleed. But melanomas usually do not cause pain.


Staging of melanoma 

If the diagnosis is melanoma, the doctor needs to learn the extent, or stage, of the disease before planning treatment. Staging is a careful attempt to learn how thick the tumor is, how deeply the melanoma has invaded the skin, and whether melanoma cells have spread to nearby lymph nodes or other parts of the body.  The following stages are used for melanoma:

Stage 0: In stage 0, the melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.

Stage I: Melanoma in stage I is thin. There is no ulceration. The melanoma cells have not spread to nearby lymph nodes.

Stage II: The tumor is at least 1 millimeter thick. Usually there is ulceration. The melanoma cells have not spread to nearby lymph nodes.

Stage III: The melanoma cells have spread to nearby tissues.  The melanoma cells have spread to one or more nearby lymph nodes.  Or, the melanoma cells have spread to tissues just outside the original tumor but not to any lymph nodes.

Stage IV: The melanoma cells have spread to other organs, to lymph nodes, or to skin areas far away from the original tumor.

According to the above, early diagnosis is very important for the life of the patient.  If the melanoma is at stage 0 or I the percentage of reaching 5 years of life is 80 to 90 %. If the melanoma is at stage II or III the percentage is between 30 to 70 %.  However if the melanoma is at stage IV the percentage is very low.   

For that reason it is very important the melanoma is diagnosed and treated when the tumour is thin and has not deeply invaded the skin.


How is melanoma treated? 

The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient's needs. Treatment for melanoma depends on the extent of the disease, the patient's age and general health, and other factors.
People with melanoma are often treated by a team of specialists. The team may include a dermatologist, surgeon, medical oncologist, radiation oncologist, and plastic surgeon.


Methods of treatment

People with melanoma may have surgery, chemotherapy, biological therapy or radiation therapy. Patients may have a combination of treatments. The doctor is the best person to describe the treatment choices and discuss the expected results.
Surgery is the usual treatment for melanoma. The surgeon removes the tumor and some normal tissue around it. This procedure reduces the chance that cancer cells will be left in the area. The width and depth of surrounding skin that needs to be removed depends on the thickness of the melanoma and how deeply it has invaded the skin.  Lymph nodes near the tumor may be removed because cancer can spread through the lymphatic system. If the pathologist finds after the biopsy cancer cells in the lymph nodes, it may mean that the disease has also spread to other parts of the body. Surgery is generally not effective in controlling melanoma that has spread to other parts of the body. In such cases, doctors may use other methods of treatment, such as chemotherapy, biological therapy (also called immunotherapy), radiation therapy, or a combination of these methods.