Melanoma: Get to Know Your Skin
What is melanoma?Melanoma is a type of skin cancer that forms in the cells that make melanin. It starts on the normal skin surface and looks like a mole. If melanoma is diagnosed early there is a better chance of cure. Early detection saves lives. Melanoma is the most serious type of skin cancer. It affects both men and women and can affect people of all ages. Over 900 cases of melanoma are diagnosed in Ireland each year.
Melanoma skin cancer is on the rise. Watch the video below to hear from the people who have experienced it first-hand.
If any of your family or friends are soaking up the sun without protecting their skin, share this #skintervention video with them.
Read more about the people in the Skintervention video
The skin is an organ, like your heart and kidneys. The skin is the biggest organ in the body. Your skin does several important jobs such as acting as a barrier and protecting everything inside your body. The skin is made up of two main layers: the epidermis on the outside and the dermis underneath. New cells are made in the deep layers of the epidermis and are pushed towards the surface. The epidermis is mainly made up of flat, scale-like cells called squamous cells. These cells make a substance called keratin, a tough, waxy substance that helps to make the skin strong enough to protect the body. At the base of the epidermis are cells called melanocytes which make a pigment called melanin. This pigment gives your skin its colour and protects it from ultraviolet (UV) rays in sunlight. Under the squamous cells are round cells called basal cells. These cells constantly divide to form new keratin-producing cells to replace the ones that wear off the skin’s surface.
If you draw a line through a melanoma, the two sides will not match
The border of an early melanoma tends to be uneven. The edges may be scalloped or notched.
Most healthy moles are all one colour. A mole with a number of different shades of brown, black or tan is a warning sign. Melanomas may also be blue, red or some other colour
Melanomas are usually larger in size than the rubber at the top of a pencil (¼ inch or 6mm)
Any change in shape, colour, size, elevation (height), or any other trait, or a new symptom like bleeding, itching or crusting is a warning sign
The photo shows a very dark mole. Darkening is one possible sign that a mole is becoming cancerous and could be a melanoma. This mole is about a centimetre across.
Melanoma with irregular border
The photo shows the irregular outline of a melanoma. Normal moles are usually much rounder, with smooth borders.
The photo shows a mole that has an area of inflammation around it. The inflamed area is about 7 millimetres at its widest but you can see that the original mole is much smaller than that. Inflammation is another sign that a mole may be developing into a melanoma and needs to be checked out by a doctor.
Melanoma with irregular shape and colour
This is an image of a very small melanoma. It is only about 4 or 5 millimetres across. But you can see clearly that it is not the same colour throughout. It also has an irregular shape. Irregular colour and shape are signs that should be checked by a doctor.
The picture shows clearly a melanoma that is spreading out from a normal mole. If you have a mole that has changed in this way, you should see your doctor as soon as possible.
CausesThe exact cause of melanoma is not known but there are certain things that increase your chances of getting the disease. These are called risk factors. If you have one or more risk factors for melanoma, it does not mean that you will definitely get the disease, but it does mean that you should be especially careful about monitoring your skin for any changes, you should be SunSmart, and you should go to your GP straight away if you notice any changes.
Lots of Moles
The more moles you have on your body, the higher your risk of melanoma. You should be very careful about exposing yourself to the sun and should keep an eye on all your moles.
People who have had sunburn are twice as likely to get melanoma as those who have not. The risk is higher if you have had sunburn several times in your life.
UV light comes from the sun. Over exposure to sunlight can cause patches of rough, dry skin called solar keratoses, which increases your risk of melanoma by up to 4 times.
Family history of skin cancer
If you have a family history of any type of skin cancer then your risk increases.
Using a sunbed, even just once, increases your risk of melanoma by 20%. Using a sunbed before the age of 35 increases your risk by almost 60%. Never, ever use sunbeds.
Sun exposure then and now
People who are exposed to strong sunlight now and then, for example if you live in Ireland and holiday in a hot country, are more at risk of melanoma than people who are continuously exposed to sunlight.
A very rare type, called a congenital giant melanocytic naevus, can develop into a melanoma. They are very common on the buttock.
Where you were born
Fair skinned people born in a hot country, for example Australia, have a higher risk than people who went to live in a hot country as a teenager or people with similar skin colouring who live in cooler climates.
Always wear sunscreen
Apply the cream 20-30 minutes before going out into the sun. Apply thickly and evenly every 2 hours no matter how high its protection. Apply the equivalent of a shot glass full of sunscreen to each limb and to your body and about half this much to your face. Always reapply after swimming or perspiring. Remember no sunscreen gives 100% protection from the sun.
Sunscreen with UVA protection
Choose a sunscreen that has good protection against UVA rays as well as a high SPF. This is because both UVB and UVA rays can cause skin cancer. In Ireland, the level of UVA protection might be shown in one of two ways
- Star rating
- A symbol with the letters UVA inside a circle
Avoid the sun between 11am and 3pm…
...as this is when the sun´s rays are strongest. This applies all year round, not just in summer. It is important to remember that the sun's rays are present even on a cloudy day.
Wear protective clothing
Clothing should be dark and tightly woven and cover your arms and legs. Wear a broad-brimmed hat that provides lots of shade. Remember to protect your eyes too by wearing sunglasses. Choose a wraparound pair that give UV protection. Check the sunglass tags to ensure that they give good protection. You can look out for these quality marks:
- European Standard EN1836
- British Standard BS 27241987
Never, ever use sunbeds
Sunbeds are not a safe alternative to tanning outdoors. The intensity of some of the UV rays they give off can be 10 to 15 times higher than that of the midday sun. Using a sunbed, even just once, increases your risk of melanoma by 20%. Using a sunbed before the age of 35 increases your risk by almost 60%.
What to do if your mole changes
Go to your GPThe signs of melanoma are that a mole has changed in size, shape and colour or it looks red and inflamed, oozes, bleeds, is crusty or is itchy or painful. If you notice any of these changes, you should see your GP without delay. Your GP will look at the mole and ask you what you have noticed about it. He or she will examine your skin and if they think that your mole looks as if it might be melanoma, they will arrange for you to see a skin specialist, called a dermatologist. You should be seen within 2 weeks.
Seeing a dermatologistWhen you have your appointment with the dermatologist, they will examine your skin again. He or she may ask you about your family history of melanoma as well as other questions about your health and especially your skin. The dermatologist might use two different tests to establish if you have melanoma:
- A skin exam, which is also called a dermatoscopy
- An excision biopsy
Skin Exam/ DermatoscopyA dermatoscopy may be used by the dermatologist to help make the initial diagnosis. The doctor uses an instrument called a dermatoscope to closely examine the suspicious area on your skin. The doctor puts some oil on to your skin and then holds the dermatoscope in their hand, a bit like a magnifying glass. This can magnify the area by up to 10 times so that the doctor can see it very clearly. It is completely painless.
Excision biopsyA biopsy means taking a sample of cells and looking at them under a microscope. However, in the case of a suspicious mole, instead of taking just a sample, the dermatologist or a plastic surgeon will take the entire mole. This is called an excision biopsy. When you go to have your mole removed, the nurse or doctor will ask you to lie down on a couch in the treatment room. First you have an injection of local anaesthetic into the area close to the mole to numb it. The doctor then cuts out the mole. He or she will also remove 2mm of tissue around the mole to help ensure that, if the mole is cancerous, that they have removed all of the cancerous cells. The mole is then sent to the laboratory for close examination under a microscope. You may need to have a few stitches in the place where the mole was removed. These will usually dissolve after a few days, or you may need to go back to the doctor's office to have them removed. You may get your biopsy results at the hospital or at your GP surgery. If the mole contained any cancerous cells you may need to have more tests. If not, you will not need any more treatment. Your doctor will discuss this with you. If your mole contained cancerous or precancerous cells, a tissue specialist (histopathologist) will look at the biopsy tissue very closely in the laboratory. Your doctor will ask you to go into hospital for an operation to take away more tissue. This aims to remove any abnormal cells that may have been left behind in the area close to the melanoma. It reduces the chance of the melanoma coming back in the future. The operation is called a wide local excision. You can read more about this in the Surgery section under the Treatment part of this website.
Further testsIf you are found to have melanoma, your doctor will check how deep the melanoma is. The depth of the melanoma in the skin affects how likely it is to come back and whether it may spread. If you have early stage melanoma that is only in the surface layers of the skin, the melanoma is very unlikely to have spread anywhere else. You will not need to have further tests. If you do need further tests, your medical team will discuss these with you. These tests may include a sentinel lymph node biopsy, CT scan, ultrasound scan, MRI scan, PET scan with CT, and/or a bone scan.
Treatment for MelanomaThe treatment for melanoma depends on what state the cancer is diagnosed at. The stage of a melanoma describes how deeply it has grown into the skin, and whether it has spread. The tests you have to diagnose your melanoma will give some information about the stage. In Ireland, most melanomas are found at an early stage when the chance of cure is very high.
SurgeryMelanoma is usually diagnosed by removing an abnormal mole in a procedure called an excision biopsy. This involves cutting out the mole as well as 2mm of normal looking skin around it. You usually have this procure under local anaesthetic in your dermatologist's office. The doctor will send the mole to the laboratory to check if it is melanoma. If you do have melanoma, you may have a second operation call a wide local excision to take away more tissue than was removed in the excision biopsy. This procedure will remove any abnormal cells that may have been left behind in the area close to the melanoma. This will probably be done under a local anaesthetic. If your surgeon is going to check the lymph nodes at the same time using a sentinel lymph node biopsy, you will have this procedure under general anaesthetic. The operation is much the same as having your mole removed, but the surgeon will take more tissue away, usually down to the level of the muscle. How much tissue they take will depend on:
- How much of the mole was left behind in the surrounding skin
- How deeply the melanoma has grown into the tissue beneath the skin
- The position of the melanoma on the body
- Whether the surgery will affect your movement afterwards (for example, if the melanoma is close to a joint)
What happens after surgery?If you had a very early melanoma that was only in the very top layer of skin (called an in situ or stage 0 melanoma) you will have one appointment at the follow up clinic. Your doctor or nurse will show you what signs to look out for that would tell you if your melanoma has come back. These include
- Changes in other moles
- Dark, mole like, spots appearing near where your melanoma was removed
- Enlarged glands (lymph nodes) close to where you had the melanoma removed
- If you notice any of these changes, contact your specialist or nurse to arrange an appointment to go back to the clinic.
Melanoma can recurIf you have already had melanoma, it is important to note that you are more at risk of developing a second melanoma either in the same place or elsewhere on your body. You must remain vigilant, follow the SunSmart code, check your body regularly following the ABCDEs and visit your doctor regularly so that they can examine your skin.
Treatments for advanced melanoma
ChemotherapyChemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body. You may have chemotherapy as a treatment for advanced melanoma that has spread to another part of the body. Or you may have chemotherapy to try to stop your melanoma coming back if melanoma cells were found in your lymph nodes when the melanoma was removed. Chemotherapy used in this way is called adjuvant chemotherapy. It hasn't yet been proven that it helps to prevent melanoma from coming back so this treatment is given as part of clinical trials. You can have chemotherapy for melanoma
- As tablets or capsules that you swallow
- As a liquid into a vein
- Into one arm or leg as regional chemotherapy
RadiotherapyRadiotherapy uses high energy rays to kill cancer cells. You may have radiotherapy for advanced melanoma. It is usually used if the melanoma has spread to other parts of the body such as the brain or spinal cord. Radiotherapy can also help to relieve pain.
Biological treatmentsBiological therapies are treatments that use substances made naturally by the body, or that change chemical processes in cancer cells. Some of these treatments are called immunotherapy because the drugs stimulate the immune system or occur naturally as part of the immune system. Other types used include BRAF inhibitors, and monoclonal antibodies. Biological therapies can help some people with advanced melanoma. They don't cure the melanoma but can control it for a time.
About other forms of skin cancerVisit our website for information on other forms of Skin Cancer
Out and About
The Marie Keating Foundation mobile information units are helping people across Ireland to Spot the Difference. Throughout the summer, the mobile information units, each staffed by a registered nurse, will be visiting schools, community centres, shopping centres, and offices to give people free advice about skin cancer. The Marie Keating Foundation nurses will be handing out free samples of SPF 50 sunscreen, kindly provided by La Roche Posay, alongside information on how to prevent and detect skin cancer at its earliest stages.
If you would like to arrange for the Marie Keating Foundation mobile units to visit your community centre, office, or organisation, please contact us. This is a completely free service and the Foundation would be delighted to help your organisation learn how to Spot the Difference.