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Skin changes its appearance all the time. Most changes are harmless even if they might be unwelcome. Sometimes, though, a skin change may be a sign of a more serious problem. A new dark spot on the skin, for instance, may be nothing, or it may signal the onset of melanoma, an invasive and fast-growing skin cancer.
What is melanoma?
Melanoma is a common and serious skin cancer affecting the skin’s pigment cells, or melanocytes. Depending on its stage of progression, melanoma is treated with some combination of surgery, radiation therapy, immunotherapy, or chemotherapy.
Melanoma is the fifth most common cancer in the U.S. with nearly 80,000 new cases a year. Although it is less common than other skin cancer, melanoma accounts for an overwhelming majority of skin cancer deaths each year.
Melanocytes reside in the bottom layer of the epidermis, or outer skin. They produce melanin, a brown pigment, when the epidermis is burned by ultraviolet light. Melanoma results from the uncontrolled growth of melanocytes due to genetic mutations. In one out of four melanoma patients, cancer originates in a pre-existing mole.
Melanoma is a rapidly-developing and invasive cancer. The initial melanoma growth will appear as a dark, steadily growing spot. As the tumor progresses, it will penetrate deeper into the skin until it reaches blood vessels. From there it can spread to nearby areas of the skin and the lymph nodes. Eventually, cancer will spread to other parts of the body, usually the lungs, central nervous system, digestive system, and skin.
The highest risk factor for melanoma is sun exposure. Chronic sun exposure isn’t the culprit, rather it’s intermittent, intense exposure resulting in sunburn. Other risk factors include the use of tanning beds, family history of melanoma, and previous history of cancers. Unlike other cancers, melanomas are most likely to occur in people between the ages of 25 and 50.
How is melanoma diagnosed?
Melanoma is usually caught in a routine skin examination by a nurse or primary care physician. In its initial stage, melanoma typically has no symptoms other than a dark spot on the skin. If the cancer spreads to other parts of the body before being detected, symptoms may include headaches, seizures, vision changes, trouble breathing, coughing, back pain, fevers, or night sweats. By that point, however, the cancer has become a serious and life-threatening condition.
Fortunately, melanoma is typically discovered in its earliest stages. Since early detection is so important, it’s good to know what to look for. Healthcare providers use the ABCDE criteria to identify melanoma:
- Asymmetry: The spot is not symmetric
- Border: The border is ragged and uneven rather than smooth
- Color: The spot has more than one color or shade
- Diameter: The spot is more than 6 mm (1/4 inch) in diameter
- Evolution: The spot is growing or changing
- When was the spot first identified?
- Has it grown or changed?
- Are there other recent symptoms such as headaches or weight loss?
Once a lesion has been discovered, a dermatologist or oncologist will remove the entire lesion for analysis by a pathologist. The biopsy will confirm the diagnosis of melanoma and determine its stage. The physician will also examine the rest of the skin area for other lesions and order blood tests.
When the diagnosis is confirmed in the lab, several other tests will be required to determine if the cancer has spread:
- Sentinel lymph node biopsyÅ—sentinel nodes are the lymph nodes closest to a tumor and will be the first part of the lymphatic system the cancer spreads to
- Brain MRI
- CAT scan of the chest and abdomen
- PET scan of regions of the body
- Lymph node ultrasounds
All these tests are necessary for determining what stage the cancer is in:
- Stage 0 melanoma, or melanoma in situ (“in place”), is a primary tumor on the outer layer of the skin. Total removal of the tumor and surrounding tissue typically clears the cancer for good.
- Stage I melanoma has penetrated 1mm to 2 mm into the skin tissue with or without a sore.
- Stage II melanoma involves the tumor penetrating 1 mm to 4 mm into the skin with or without a sore. Stages 0-II are the “tumor stage” of the disease.
- Stage III melanoma (nodal stage) has spread to the lymph nodes and possibly other areas of the skin.
- Stage IV melanoma (metastatic stage) has spread to the lymph nodes, brain, lungs, liver, other organs, and distant areas on the skin. The 5-year survival rate for stage IV melanoma is very low.
Melanoma treatment options
Depending on the stage, melanoma is primarily treated with a combination of surgery, radiation, and medications. A cancer care team will consist of a surgical oncologist (cancer doctor), medical oncologist, radiation oncologist, dermatologist, radiologist, and nurses. They will work together in designing and implementing a treatment plan.
Surgery
The goal of surgery is to remove all of the cancer from the body. Most patients are first diagnosed with early-stage melanoma. A layer-by-layer surgical excision of the tumor and surrounding tissues, called Mohs surgery, is usually enough to resolve early-stage melanoma without additional treatment. More advanced melanoma may require surgical removal of the lymph nodes, called a lymphadenectomy. Surgery is usually followed by radiation therapy or medications to clear any remaining cancer from the body, called adjuvant therapy.
Radiation therapy
A radiation oncologist uses targeted X-rays to destroy melanoma cancer cells. It can be used with medications and is often used after surgery to prevent cancer recurrence. For inoperable melanomas, radiation therapy is often used to relieve symptoms, called palliative treatment.
Medications
A medical oncologist may prescribe medications at any stage of cancer, but they are more commonly used in the advanced stages of melanoma. Called “systemic therapy,” melanoma medications are designed to kill melanoma cancer cells. They do this by specifically targeting genetic mutations in the cancer cells (targeted therapy), ramping up the immune system (immunotherapy), or killing the cancer cells outright (chemotherapy). Because of the superior results of immunotherapy and targeted therapy, chemotherapy is a second- and even a third-line treatment for melanoma.
Melanoma medications
Melanoma medications work on a few basic principles. Targeted therapy, the treatment of choice for advanced melanoma, target specific genes in cancer cell DNA that are different from normal genes. Immunotherapy drugs fire up the body’s immune system to fight off and kill tumors. Oncolytic virus therapy uses specially engineered viruses to infect and kill only tumor cells. Finally, chemotherapy drugs used for melanoma kill tumor cells outright.
Targeted drug therapy
The cornerstone of contemporary treatment for advanced melanoma is “targeted” therapy. These agents specifically target mutated genes in melanoma cells that are vital for growth and function. Because these mutations are not found in other cells in the body, targeted therapy shuts down melanoma cells without harming other cells. Also called kinase inhibitors, these drugs are often more effective when used in combination.
BRAF inhibitors target a mutated gene (BRAF) that produces a protein vital to cell survival. 70% of melanoma cancer cells have a mutated BRAF gene. Vemurafenib (Zeboraf), dabrafenib (Tafinlar), and encorafenib (Braftovi) are BRAF-inhibitors prescribed to patients with inoperable metastatic melanoma.
MEK inhibitors block another important mutated gene (MEK) and include trametinib (Mekinist), cobimetinib (Cotellic), and binimetinib (Mektovi). These drugs, too, are prescribed to patients with advanced metastatic melanoma.
Finally, imatinib (Gleevec), dasatinib (Sprycel), and nilotinib (Tasigna) target the mutated C-KIT gene in melanoma cells.
Monoclonal antibodies (checkpoint inhibitors)
The immune system naturally fights off melanoma tumors. Immunotherapies target checkpoint proteins on immune system cells that, when activated, slow down the activity of the immune cell—essentially these checkpoint proteins put immune cells into “park.”
Monoclonal antibodies have been designed to block the two most important checkpoint proteins, cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1). CTLA-4 inhibitors are represented by ipilimumab (Yervoy) and PD-1 inhibitors include nivolumab (Opdivo) and pembrolizumab (Keytruda).
Cytokines
Cytokines are naturally produced by cells in the body and send signals to the immune system. They are the chemical messaging service between the body’s cells and the immune system. Both interferon (IFN) alfa-2b and a slightly modified version, peginterferon alfa-2b (Peg-IFN), are cytokines that activate immune cells such as T-cells, lymphocytes, and killer cells to target and kill invaders or cancer cells. For melanoma, both interferon and peginterferon are used as adjuvant therapy for other drug therapies.
Oncolytic virus therapy
Oncolytic (“cancer-dissolving”) viruses are genetically modified to only reproduce within cancer cells, so they don’t affect or kill normal cells. Talimogene laherparepvec, or T-VEC, is a genetically modified herpes simplex virus injected into a melanoma tumor to kill only melanoma cells rather than surrounding tissues.
Chemotherapy
Chemotherapy is only a second- or third-line treatment for melanoma after other drug therapies, radiation, or surgery hasn’t worked. These drugs are more often used to provide palliative care for melanomas that cannot be treated. Chemotherapy in general does not show survival benefit or increase in remission of the disease. Dacarbazine, temozolomide, and cisplatin are the most commonly prescribed. These drugs may be prescribed for early-stage melanoma to prevent the disease from progressing.
Isolated limb perfusion
In advanced melanoma when a single arm or leg has too many tumors to surgically remove, the alternative to amputating the limb is isolated limb perfusion. Blood flow to the limb is cut off and cytotoxic (cell-killing) medications, such as phenylalanine mustard and actinomycin D, are pumped through the leg’s blood vessels for 60-90 minutes.
What is the best medication for melanoma?
The treatment of melanoma will be determined by the stage of progression, the cancer’s response to therapy, and the patient’s tolerance of side effects. First-line medications are typically targeted therapy drugs and immunomodulators, but there is no “best” medication for melanoma.
| Best medication for melanoma | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Zelboraf | Kinase inhibitor | Oral | Four 240 mg tablets twice daily 12 hours apart | Joint pain, rash, hair loss |
| Tafinlar (dabrafenib) | Kinase inhibitor | Oral | Four 240 mg tablets twice daily 12 hours apart | Thickening of the skin, headache, fever |
| Mekinist (trametinib) | Kinase inhibitor | Oral | 2 mg tablet taken twice daily after a meal | Rash, diarrhea, swelling |
| Yervoy (ipilimumab) | Antibody | Infusion | One dose every three weeks for a total of four doses. Dose depends on weight | Fatigue, itching, rash |
| Keytruda (pembrolizumab) | Antibody | Infusion | 8 ml of 100 mg/4 ml every three weeks | Fatigue, pain, itching |
| Intron A (Interferon alfa-2b) | Immunomodulator | Infusion | 20 million IU/m2 for 20 minutes five days a week for four weeks | Fatigue, low white blood cell counts, fever |
| Dacarbazine | Antineoplastic | Injection | One dose daily for 10 days. Dose depends on weight | Loss of appetite, nausea, vomiting |
| Temodar (temozolomide) | Antineoplastic | Oral | One and a half 100 mg capsules daily for five days | Hair loss, fatigue, nausea |
| Imlygic (talimogene laherparepvec) | Oncolytic virus | Injection | Four ml of 106 units per ml | Flu symptoms, fatigue, injection site pain |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of melanoma medication?
Side effects of melanoma medications will vary depending on the medication, the dose, the patient’s tolerance, as well as other drugs and therapies.
Targeted therapy drugs are different from one another and so might have different side effects. The most common are swelling, headache, fever, and tiredness. Many of the side effects involve the skin, such as rash, itching, and sun sensitivity, so patients will usually have follow-up visits with a dermatologist to manage side effects. The most serious side effect of these drugs is low blood cell counts.
Antibodies used to treat melanoma typically cause diarrhea, fatigue, skin rash, and nausea. The most serious side effect is liver damage and intestinal swelling. Overall, these medications are well tolerated, however, patients should be closely be monitored for thyroid and adrenal dysfunctions.
Cytokines ramp up the immune system, so the most common side effects are flu symptoms, that is, immune-related symptoms. Fever, runny nose, chills, and headache are typical. The most serious side effect is liver damage.
T-VEC is a live and infectious virus, so the most common side effects are flu-like symptoms when the body responds to the virus. It is not uncommon to feel discomfort or pain at the injection site.
Cancer chemotherapy drugs don’t distinguish between cancer cells and normal cells. Instead, they affect fast-growing cells like cancer cells. Side effects usually involve injury to other fast-growing tissues, such as the blood, the mouth, hair follicles, and intestines. Side effects include bleeding, bruising, mouth sores, hair loss, nausea, and vomiting. Fatigue, weakness, and “feeling bad” (malaise) are also commonly experienced.
What is the best home remedy for melanoma?
Melanoma is a serious and aggressive cancer that can quickly spread to other parts of the body. Life expectancy, even with treatment, drops rapidly as the cancer spreads. For any suspected skin cancer, the best remedy is to see a healthcare professional right away. Once diagnosed, the only way to effectively treat melanoma is with surgery, radiation, and medications.
That being said, melanoma treatment can be hard to endure. Side effects from treatment can be painful and debilitating. The psychological and emotional toll can be significant. Diet, activity, and lifestyle changes can help limit the problems associated with cancer treatment and improve overall well-being:
- Eat nutritious meals
- Exercise
- Keep a regular schedule
- Take advantage of complementary therapies such as acupuncture, meditation, music therapy, or yoga
Frequently asked questions about melanoma
Is Melanoma curable?
At the earliest stages, melanoma can be completely cleared from the body. Advanced melanoma has low survival rates even with treatment.
Is melanoma flat or raised?
The initial melanoma lesion is flat unless it develops on a pre-existing mole, in which case it will be raised and smooth. The tumor usually grows downward and outward into the skin rather than up. Melanoma lesions are characterized by an asymmetric shape, ragged border, variations in color, and steady evolution.
What is the survival rate for melanoma?
Melanoma survival rate depends on how far the cancer has progressed when first treated. Stage 0 melanoma has a five-year survival rate near 100%. Stage IV melanoma that has spread to other parts of the body has a five-year survival rate of 7%-19%.
What is the most effective treatment for melanoma?
Melanoma treatment will depend on how far the disease has progressed, its responsiveness to treatment, and the patient’s tolerance for side effects. The goal of most treatments is to eliminate cancer from the body, but sometimes the best treatment can offer is to relieve symptoms. New medications such as checkpoint inhibitors have shown promising results in recent literature.
What is the new drug for melanoma?
Adoptive T-cell therapy (ACT) is among the most promising new therapies for the treatment of melanoma. ACT isolates tumor-specific white blood cells from patients, grows them in large volumes in the laboratory, and reinjects them back into the patient to fight the cancer. ACT can also be used as a cancer “vaccine” to prevent a recurrence. Right now, however, the procedure is too expensive to use outside of a few specialized or highly subsidized settings.
What foods fight melanoma?
Melanoma is a fast-growing and aggressive cancer that is only stopped by a combination of surgery, radiation therapy, and medications. Foods and nutrients do not fight or kill melanoma tumors, but a healthy and nutritious diet will help reduce the side effects of treatment and speed recovery. A diet rich in antioxidants and vitamin D may help prevent the formation of melanoma or other skin cancers.
What are the side effects of immunotherapy for melanoma?
Melanoma is treated with surgery, radiation therapy, and a variety of medications including chemotherapy, immunotherapy, and targeted drug therapy. Patients with advanced melanoma will often require a combination of treatments. Side effects will vary depending on the treatments used and the severity of the underlying cancer.
What kills skin cancer cells?
Melanoma cells are difficult to eliminate. They are resistant to both radiation and standard chemotherapy medications. The most effective medications target mutated genes in the cancer cells or assist the immune system in fighting and killing the tumor.
How do doctors treat melanoma?
Melanoma is treated with surgery, radiation therapy, or medications depending on how far the cancer has progressed when treatment begins.
How do you know melanoma has spread?
A single melanoma tumor spreads downward into the skin tissue and only slowly increases in diameter. When the cancer begins to spread in the lymphatic system, it will often cause other tumors on the skin, called in-transit tumors, between the original tumor and nearby lymph nodes. If you notice a suspicious spot or a mole that has started to grow, it’s time to see a healthcare provider.
Can melanoma be cured naturally?
Melanoma is a fast-growing, fast-spreading, and deadly cancer. It can only be cured with surgery, radiation treatment, and special medications. However, the more it progresses, the more deadly it becomes, so it’s not a good idea to spend time trying to cure it naturally.
Can coconut oil heal skin cancer?
Coconut oil may inhibit the production of free radicals in skin tissues, so some people advise applying it to the skin to prevent skin cancers. Coconut oil cannot heal skin cancer once it’s started.
Does sugar feed melanoma?
Cancer cells use sugars at a much higher rate than normal tissues. For this reason, a PET scan can identify the spread of melanoma tumors throughout the body using a sugar radiotracer. In the PET scan, the melanoma tumors are brighter than surrounding tissues because of their elevated sugar use.