Melanoma

Risk Factors

• UV radiation exposure: Sun exposure and tanning bed use are major risk factors.
• Severe sunburns, especially in childhood: Increases lifetime melanoma risk.
• Fair skin and light-colored eyes: Less natural protection from UV damage.
• Family history: Having a close relative with melanoma increases risk.
• Atypical moles (dysplastic nevi): Irregular, large moles have higher cancer risk.
• Weakened immune system: Medications or conditions that suppress immunity increase risk.

Spotting Melanoma: The ABCDE Rule

• A — Asymmetry: One half doesn't match the other.
• B — Border irregularity: Edges are ragged, notched, or blurred.
• C — Color: Multiple colors within one mole (brown, black, tan, red, blue).
• D — Diameter: Larger than a pencil eraser (6mm).
• E — Evolving: Changing in size, shape, or color over weeks or months.

Any mole with these features should be examined by a dermatologist immediately.

Diagnosis

Melanoma diagnosis involves:

• Skin biopsy: A sample of the suspicious mole is removed and examined under a microscope. This is the only way to confirm melanoma.
• Dermoscopy: A special magnifying tool helps dermatologists examine moles in detail.
• Imaging (CT, MRI, PET): Used if melanoma is confirmed to check for spread to lymph nodes or organs.

Staging

Melanoma staging is based on:

• Breslow thickness: How deep the melanoma penetrates the skin.
• Ulceration: Whether the skin over the melanoma is broken.
• Lymph node involvement: Whether cancer has reached nearby lymph nodes.
• Metastasis: Whether cancer has spread to distant organs.

Five-year survival rates: Stage I ~97%, Stage II ~87–95%, Stage III ~41–78%, Stage IV ~10–30%. Early detection is life-saving.

Treatment Options

Surgery

Surgical excision is the primary treatment:

• The melanoma and surrounding healthy tissue (margin) are removed.
• Sentinel lymph node biopsy: Removes the first lymph node(s) to which cancer is most likely to have spread.

Immunotherapy (Checkpoint Inhibitors)

These drugs help the immune system recognize and attack melanoma cells:

• Pembrolizumab (Keytruda) and nivolumab (Opdivo) are standard options.
• Can be used after surgery (adjuvant) or for advanced disease.
• Often highly effective but can cause immune-related side effects.

Targeted Therapy

For melanomas with specific mutations:

• BRAF inhibitors (vemurafenib, dabrafenib) + MEK inhibitors for BRAF-mutated melanomas.
• KIT inhibitors for KIT-mutated melanomas (less common).

Combination Therapy

Combining immunotherapy with targeted therapy often improves response.

Radiation Therapy

Used to treat brain metastases or other localized areas of spread.

Chemotherapy

Less commonly used now that immunotherapy and targeted therapy are available, but may be used in certain situations.

Common Side Effects and Management

• Fatigue: Common with immunotherapy; manage with rest and activity pacing.
• Skin reactions: Rash or itching at the injection site; usually manageable.
• Immune-related adverse events (irAEs): Immunotherapy can trigger inflammation in the lungs, heart, kidneys, or other organs. Report any new symptoms immediately.
• Diarrhea: Anti-diarrheal medications help.
• Joint or muscle pain: Pain management strategies help.

Immunotherapy side effects can be serious; close monitoring and communication with your team are essential.

Prevention and Early Detection

• Protect from UV: Limit sun exposure, use SPF 30+ sunscreen, wear protective clothing.
• Avoid tanning beds: Significantly increase melanoma risk.
• Self-exams: Check your skin monthly using the ABCDE rule.
• Professional screening: Annual skin exams by a dermatologist if you have risk factors.