learn about melanoma
Cause | Prevention | Vitamin D & Sunlight | UV Index | Early Detection | ABCDE | Stages | Treatment | Prognosis
Melanoma is the most lethal form of skin cancer. The incidence of melanoma in Australia and New Zealand is 12 times the global average rate. Over 14,000 cases were diagnosed in 2018, which is a 65% increase since 2000. 1905 deaths were caused by melanoma in 2018.
Melanoma is the third most common form of cancer for both men and women. It is the most common cause of cancer for Australians aged 15 to 39 years.
Melanoma typically develops in the skin as a growth of abnormal melanocyte cells.
Normal melanocyte cells exist in the epidermis (the outer layer of the skin) . They produce melanin, which is the pigment that is responsible for colouring the skin, eyes and hair. Melanoma is usually caused by melanocytes being over exposed to UV rays, particularly with sunburn and especially during childhood. The effect is cumulative. The more exposure over time, the higher the risk of melanoma.
Melanoma sometimes occurs in other parts of the body that are not typically sun-exposed including under finger or toe nails (subungual melanoma).
Melanocytes also exist in the eye, the heart, bowel, inner ear, bones and membranes of the central nervous system.
The risk of melanoma is highest for those people who have:
- Fair skin, freckles, red hair, light coloured eyes and a tendency to burn rather than tan
- A family history of melanoma
- An increased number of unusual moles (dysplastic naevi)
- Depressed immune system (including transplant patients on immune-suppression treatments)
- Previous melanoma or non-melanoma skin cancers
The majority of melanomas are caused by UV (sun) exposure.
It is important to avoid over-exposure to the sun and sunburn. Escape the sun. Seek shade. Wear clothes that protect you from the sun, and a hat that protects your face, ears and the back of your neck.
Use a broad spectrum SPF50+ sunscreen, and keep applying it especially if swimming.
Vitamin D and Sunlight
You get most of your Vitamin D through sun exposure. Short incidental exposure is all that is needed. Getting sufficient vitamin D can be achieved by exposure to the sun morning and late afternoon - outside the times that the UV rating is 3 or higher.
Small amounts of vitamin D are also found in foods such as fish, eggs and liver. Vitamin D helps with calcium absorption to keep bones healthy, reduce the risk of broken bones in falls and reduce the risk of rickets (severe vitamin D deficiency that causes bone deformities).
The UV index changes through the day and is generally lower in the morning and late afternoon. In most parts of Australia sun protection is required when the UV Index is 3 or higher.
The daily UV Index for your location can be found through the Bureau of Meteorology’s daily UV forecast (see www.bom.gov.au).
Click on image above to enlarge
Early detection is crucial, and effective. Melanoma can almost always be treated successfully if found early, which is why it is important to check your skin for any signs of change. However, because of its aggressive nature, it can quickly become life-threatening.
Know your skin and check it regularly. We also recommend that you get your partner (or doctor) to regularly check you all over.
Watch out for new spots or spots that change. Early melanomas are often flat changing lesions. DO NOT wait until they become raised, sore or bleed. A changing mole is a suspicious mole. Get it checked NOW.
If you have any concerns about your skin, or notice any changes, consult your GP or dermatologist immediately.
Use the ABCDE guide when checking yourskin (or your partner's skin).
A - Asymmetry
- Benign (non-cancerous and non-malignant) are usually round in shape (symmetrical).
- Melanoma lesions are typically irregular in shape (asymmetrical).
- Benign moles have smooth even borders.
- Melanoma lesions often have uneven borders (ragged or notched edges).
C - Colour
- Benign moles are usually a single shade of brown.
- Melanoma lesions often contain multiple colours (brown, black, pink, red or purple).
D - Diameter
- Benign moles are usually less than 6mm in diameter
- Melanomas are often more than 6mm in diameter.
E - Evolving
- Benign moles usually do not change over time
- Melanomas often grow in shape or change in height
There are 5 stages of melanoma (0-IV) and these are based on its thickness and whether or not it has spread to other parts of the body.
Early stages of melanoma are confined to the epidermis (in-situ, stage 0) or less than 2mm thick (stage 1) and have not spread. Stage III and IV are more advanced stages of melanoma where it has become metastatic and spread to either the lymph nodes or other parts of the body (lungs, liver, brain or bones.). Advanced stage melanoma spreads through the body via the lymphatic system, or travels through the blood system. When this happens, small cells of the original melanoma circulate throughout the body and attach themselves to other parts of the body. Then they start to multiply. The cancer is then said to be metastatic.
Patients diagnosed with melanoma will need to have the melanoma surgically removed. Some stage I and II patients might also need a lymph node biopsy to determine whether there has been spread of the disease to a nearby lymph node.
Patient experiences are very different. Those with early
stage melanoma will need to have their melanoma surgically excised with a
margin. They will then need regular check-ups as the risk of a second melanoma
is increased. Regular check-ups will enable early detection of any new lesions,
as well as early detection of disease recurrence around the scar, in the skin
or lymph nodes should this happen.
Those with advanced melanoma have very different
experiences. Treatment is multifaceted and some elements can have side-effects.
There are several therapies for the treatment of advanced melanoma including
surgery, radiation therapy, immunotherapies and chemotherapy. New drugs are now
emerging which are showing very promising results.
Much will depend on the patient’s stage of melanoma,
their age and general health. If diagnosed early, the five year survival rate
is 91% rising to nearly 100% if the melanoma has not spread.
The prognosis for advanced stage melanoma (stages III and
IV) is poorer. The five year survival rate is 65% for stage III disease, but
falls to 5% if the cancer is widespread.