What is melanoma and why do we need more research?

This type of melanoma tends to spread on the surface of the skin for a while before it starts spreading down into the skin. It can appear almost anywhere of the body, most commonly on places that are more often exposed to the sun – the legs in women, the torso in men, and the upper back in both.

This type also tends to spread on the surface of the skin. It often develops in older patients, typically on sun-damaged skin. It can look like a flat or raised, blotchy patch with uneven borders, and either blue-black or tan-brown in colour.

This type of melanoma often appears in hard-to-spot places like under nails and on the soles of the feet or palms of the hands. It is the most common type in people of colour, and may appear as a black or brown area.

These cases are melanomas that lack colour – they are missing the melanin that give most moles and melanomas their colour.

Melanoma usually looks like a dark mole anywhere on the skin or eyes. It can appear as a new mole or an existing mole may change size or shape and a helpful way to remember the key signs is to think ABCDE:

Asymmetry: Is the mole asymmetrical? Meaning it is not a neat, mirrored shape.
Border: Does the mole have an uneven border?
Colour: Is the colour of the mole uneven, or is there more than one colour in the mole?
Diameter: Is the mole larger than 5mm across?
Elevation: Is the mole elevated or becoming raised?

Other symptoms of melanoma include moles that are itchy, painful, inflamed, or bleeding. A dark area under a nail, not caused by injury, can also be a sign of melanoma, as can an unusual mark on your skin that has not gone away after a few weeks.

If your doctor suspects you may have melanoma, they normally refer you to a dermatologist. This skin specialist will take a closer look at the mole under a dermascope (a kind of handheld microscope) to look for signs of cancer. If they suspect the mole is cancerous, they might remove the mole, along with a margin of healthy skin around the mole, and send it away to be tested in the lab to see if it is cancerous.

Diagnosed melanoma can be categorised as stages 0-4:

Stage 0 - melanoma in situ, meaning the cancerous cells are only on the surface of the skin.

Stage 1 - melanoma at an early stage (less than 2mm thick) with no sign of spread to other areas.

Stage 2 - Melanoma that hasn't spread from the skin but has become thicker and may be ulcerated.

Stage 3 - Melanoma that has spread to nearby lymph nodes or to an area between the melanoma and lymph nodes.

Stage 4 - Melanoma that has spread to other parts of the body and nearby lymph nodes. 

Older people are more likely to develop melanoma. In general, cancer becomes more likely to occur as we age because mutations in our DNA build up - this makes cancer more likely to occur. However, melanoma is relatively more common in younger people compared to some other types of cancer. This means it is important to look for the signs of melanoma no matter your age, and protect yourself from too much UV exposure (another key risk factor).

UV rays (radiation), which cause sunburn, can cause DNA damage. The sun is the most important source of UV, however sunbeds also emit high levels of UV radiation. If enough DNA damage accumulates, cancer can occur. This means it is important to reduce your exposure to UV to prevent melanoma and other skin cancers occurring. It will not prevent every case, however it is estimated that 85% of cases in the UK are caused by too much UV exposure.

Some people may be more likely to develop melanoma due to differences in their skin. People with fair or very fair skin are more at risk of developing melanoma. You are also more at risk if you have freckles or have lots of moles.

In general, if you tend to burn in the sun you are more at risk of skin cancer. People with deeper skin tones can also develop melanoma. It is less common depending on skin tone and how much UV exposure a person has, and most commonly occurs on lighter areas of skin (e.g. palms of the hands and soles of the feet) or under a nail.

As with many types of cancer, a family history of melanoma may increase your risk of developing melanoma at some stage in your life. A genetic condition, called familial atypical multiple mole melanoma (FAMMM), can cause more moles that are unusually shaped and different sizes, and increase your risk of melanoma.

Melanoma can often be effectively treated with surgery, if caught before it has spread. In fact, most people with localised melanoma that have the tumour removed with surgery make a full recovery. To make sure that all of the cancerous cells are removed, a margin around the tumour will usually also be removed.

Surgery may also be used to remove more tissue if the cancer has spread, or if it returns following a previous surgery. This can involve removing large areas of skin or nearby lymph nodes. Depending on how significant the surgery is, aftercare can be important to avoid infection, and skin grafts may be used to replace the skin that was removed.

Radiotherapy, which uses bursts of radiation to kill cancer cells, is sometimes used to reduce the size of large melanomas.

If melanoma has spread, sometimes chemotherapy is used to kill cancer cells as they have spread around the body. However, it does not tend to work as well for melanoma as some other treatments.

Modern medicines, which work by targeting specific parts of the biology of cancer cells, can be used to treat melanoma in some cases. Similarly, immunotherapy, which harnesses the power of the immune system to kill cancer cells, can be an option for some patients.

These medicines are at an early stage and, while some patients respond well, others do not respond or may stop responding after initially having some benefit. A significant amount of research is being done to find new targeted treatments or improve those we have developed already.