Melanoma is a type of skin cancer that occurs in melanocytes. These are the cells that make melanin, which gives skin its colour. Melanin also protects the deeper layers of the skin from the sun’s harmful ultraviolet (UV) rays. Melanoma is the most dangerous type of skin cancer; it can spread to other parts of the body through the lymph system or the blood and early diagnosis is vital.

Melanoma can present itself as a mole, freckle or birthmark that changes in colour or increases in size or texture, bleeds or has a persistent itch. These changes are normally noticed over a period of several weeks or months rather than days. If this rings bells, book an appointment to see your GP as soon as possible.

Any race or skin colour can get melanoma, however the most at risk are people with:

• Fair white, freckled skin (and particularly red heads)
• Lot of moles, especially larger and more irregular moles called the ‘dysplastic ​naevi syndrome’
• A family history of melanoma; which doubles the risk

Melanoma grows deeper into the skin; the deeper it gets the more dangerous it becomes, which is why early detection is so important. As it progresses, cells break free and get into the tissue fluid channels (lymphatics) and are swept up to the ‘draining lymph nodes’ where the cells can take hold. These are sited in the groin, armpits and neck; the positioning of the melanoma will depend on which node will be affected.

Although more common on the back, arms and legs, melanoma can appear anywhere on the body, including those areas not exposed to the sun. There are rare forms of melanoma which can occur in the mouth, the retina, or an internal organ, without anything being visible on the skin.

Most common places for melanoma on men:

• Head
• Back
• Neck
• Trunk

Most common places for melanoma on women:

• Arms
• Legs

It is recommended that everyone should check their skin monthly, and if possible, back this up by booking an annual check with a professional. If you are in a high-risk category, you will need to increase this, however your GP will advise you on the best option for you.

Skin cancer is the most common, and melanoma is the fifth most common type of cancer in the UK. Rates of melanoma have more than doubled in the UK in the last 30 years, with incidence in women having doubled (100% increase) and for men nearly tripled (181%). It is one of our fastest rising cancers, and although still higher in older people, rates in 25-49 year olds increased by 70% over the same period*. Global cases will reach nearly half a million (466,914) by 2040, an increase of 62% on 2018 figures.

Exposure to ultraviolet radiation (UV) is the only known environmental risk factor for developing melanoma of the skin.

The “ABCDE” is a helpful way that you can determine the need for additional evaluation, especially useful when self-checking:

• Asymmetry – one half of the spot does not match the other
• Border Irregularity – the edges are uneven or blurred
• Colour – the colour is uneven or has shades of different colours
• Diameter – the area is more than five millimetres in size (about the size of a pencil eraser)
• Evolving – changing in any way including bleeding, itching or appearance

Yes, so it is important to watch for any changes in the appearance of these moles, and get any concerns checked by your GP. People with more than 100 moles have a seven-fold greater risk of developing melanoma than those with fewer moles. Having multiple moles or nevi is a higher risk factor for melanoma than having light-coloured hair and fair skin.

Yes and some are more common than others. The most common form is called superficial spreading melanoma, which tends to enlarge gradually on the surface of the skin before growing into deeper layers of skin.

Others include:

• Nodular melanoma: These are invasive (growing into deeper layers of skin) soon after they appear on the skin
• Acral-lentiginous melanoma: This is the most common type of melanoma in dark-skinned individuals. It appears on the palms, nail beds, soles of the feet, mucous membranes, and penis
• Lentigo maligna melanoma: Most cases arise in adults, primarily in the head and neck region. It is a slow growing form that can take many years before becoming invasive (growing into deeper layers of skin)
• Amelanotic melanoma: These are rare and appear without pigmentation making them difficult to diagnose, however they still show changes in symmetry, borders, and size

If concerned, your GP will refer you to a specialist who will make a definitive diagnosis following an excisional biopsy. This is a procedure that removes the mole and a margin of tissue surrounding it, or with a “punch” biopsy if it is large, or in an awkward area of the body to reach.
A pathologist will look at the sample under a microscope and determine if the cells are cancerous. The biopsy sample allows the pathologist to determine the stage of disease, upon which treatment decisions are then made.

Staging is a method that clinicians use to categorise melanoma for the purpose of evaluation, treatment, and prognosis.

• Stage I & II: Melanoma is confined to the site where the cancer occurred and has not spread to the lymph nodes or internal organs
• Stage III: Melanoma has spread to the lymph nodes
• Stage IV: Melanoma has spread to distant organs (metastasis)

Treatment decisions are based on the location and stage of the tumour, and factors specific to the individual patient.

These could include:

• Surgery – including wide margin removal and reconstruction of the tumour site, sentinel lymph node biopsy, removal of lymph nodes or metastases
• Chemotherapy/immunotherapy
• Intralesional/injectable therapy
• Radiation therapy
• Surveillance
• Clinical trials

Like many other types of cancer, melanoma is potentially curable when caught at an early stage. Once you have had melanoma however, you are at a higher risk than the general population of developing a new primary melanoma, as well as a recurrence of the original melanoma. Your GP will therefore ensure you have a regular check-up and long-lasting skin health surveillance.

Around five and 10-year survival rates for early-stage disease approach 90 percent and higher. Those survival rates gradually go down when the disease becomes more advanced. Your GP is best positioned to answer your questions based on the stage of melanoma you have.

This is a common question for patients with melanoma. The risk of developing a second primary melanoma is higher than the risk of people in the general population developing a first melanoma. Unfortunately, once you have had melanoma, you are also at risk of recurrence of the original cancer.

There are genetic variants or gene mutations, that make some individuals prone to developing melanoma. Individuals with these mutations have a strong family history of melanoma and carry a 60 to 90 percent lifetime risk of developing the disease.