What skin melanoma is
Melanoma is a malignant tumour of melanocytes, the cells that produce the pigment melanin. It most often arises on the skin, less often in the eye or on mucous membranes. Melanoma accounts for only a few percent of all skin cancers, yet it causes most skin cancer deaths because it spreads early to lymph nodes, lungs, liver, bones and brain. At the same time, melanoma found at an early stage is cured with a small operation. The key is to recognise it in time and investigate it properly.
Signs of melanoma: the ABCDE rule
- A (asymmetry): the two halves of the mole do not match;
- B (border): irregular, blurred edges;
- C (colour): uneven colour, several shades;
- D (diameter): larger than 6 mm;
- E (evolution): any change: the mole grows, changes shape or colour, itches or bleeds.
Another clue is the “ugly duckling”: a lesion that looks clearly different from the other moles. If you notice any of these signs, see a dermatologist.
Diagnosis of melanoma
Melanoma is diagnosed only on histology. The work-up has several steps.
- Examination and dermoscopy. The doctor examines the whole skin and studies suspicious lesions under magnification. Digital dermoscopy with mole mapping allows images to be compared and changes to be noticed at the earliest stage.
- Excisional biopsy. The suspicious lesion is removed completely with a small margin and sent for histology. This determines the Breslow thickness, ulceration and the rate of cell division, which define the stage and the outlook.
- Sentinel lymph node biopsy. It is done when the tumour is about 1 mm thick or more, to check whether tumour cells have reached the nearest lymph nodes.
- Imaging. Ultrasound of the lymph nodes and, when metastases are suspected, PET-CT and brain MRI.
- Molecular testing. The tumour is tested for BRAF, NRAS and c-KIT mutations. A BRAF mutation is found in about half of patients and makes targeted drugs an option.
If the mole has already been removed, the clinic abroad reviews the existing slides and blocks: the revised report quite often changes the stage and the treatment plan.
Blood tests for melanoma and tumour markers
There is no blood test that detects melanoma at an early stage. The full blood count and biochemistry stay normal with a small tumour, so melanoma cannot be “checked” by a blood test; a skin examination is needed.
Tumour markers are used after the diagnosis has been made:
- LDH (lactate dehydrogenase) rises in advanced melanoma, is part of the staging system and helps assess the outlook;
- S100 protein is used for follow-up after treatment and to assess response to therapy in metastatic melanoma.
Both can also rise for other reasons, so they are interpreted only together with other findings. Before surgery and drug treatment, a full blood count, biochemistry and liver, kidney and thyroid function tests are also done.
Stages of melanoma
- Stage 0 (in situ): the tumour is confined to the top layer of the skin;
- Stages I–II: the tumour is in the skin only; they differ by thickness and ulceration;
- Stage III: nearby lymph nodes are involved or there are deposits in the skin near the tumour;
- Stage IV: distant metastases.
How skin melanoma is treated
Stages 0–II: surgery
The main treatment is wide excision of the tumour with a margin of healthy skin of 0.5 to 2 cm depending on thickness. With thin melanoma and clear lymph nodes, treatment ends there. For thick or ulcerated stage II tumours, a year of immunotherapy may be given after surgery to lower the risk of recurrence.
Stage III: surgery and preventive therapy
The tumour and the involved lymph nodes are removed, followed by a year of adjuvant therapy: immunotherapy with PD-1 inhibitors (nivolumab, pembrolizumab) or, with a BRAF mutation, the targeted drugs dabrafenib and trametinib. Increasingly, immunotherapy is started before surgery.
Stage IV: drug treatment
- Immunotherapy: PD-1 inhibitors alone or combined with ipilimumab or relatlimab. In a considerable share of patients it produces long-lasting remission.
- Targeted therapy: combinations of BRAF and MEK inhibitors when a BRAF mutation is present; they act quickly, including with a large tumour burden.
- Radiosurgery: CyberKnife and Gamma Knife for brain metastases and isolated deposits.
- Cell therapy with tumour-infiltrating lymphocytes (TIL) and clinical trials, at selected centres.
Chemotherapy has little effect in melanoma and is rarely used today.
Prognosis
According to the SEER registry, five-year relative survival is above 98% for localised melanoma, about 75% with lymph node involvement and about 35% with distant metastases. Results at stage IV have improved markedly since immunotherapy arrived: ten years ago fewer than 10% of such patients lived five years.
Follow-up after treatment
After treatment, regular checks of the skin and lymph nodes are needed: every 3–6 months in the first years, then once a year. For stages II–IV the programme includes ultrasound, CT or PET-CT and LDH and S100 tests. Patients also examine their own skin once a month.
Melanoma treatment abroad
Clinics in Germany, Israel, Turkey and Spain offer:
- digital dermoscopy with mapping of all moles;
- pathology review by pathologists who specialise in skin tumours;
- sentinel node biopsy and tissue-sparing surgery with a good cosmetic result;
- modern immunotherapy and targeted drugs, and clinical trials;
- treatment decisions made by a board of oncologists, surgeons and radiologists.
The cost depends on the stage and the scope of tests: a consultation with dermoscopy and removal of a lesion costs many times less than a work-up with PET-CT and sentinel node biopsy. The clinic prepares an exact plan with prices after reviewing the records. See clinics in the oncology section.
Frequently asked questions
Can melanoma be cured?
Yes. At early stages surgery cures it in the great majority of cases. With metastases, modern drugs allow many patients to live for years.
Which doctor treats melanoma?
A dermatologist or skin cancer specialist does the first examination; treatment is led by an oncologist and a surgical oncologist.
Which tests should I have if melanoma is suspected?
Start with dermoscopy, not blood tests. Only histology of the removed lesion confirms the diagnosis.
Can moles be removed by laser?
Suspicious lesions, no: laser leaves no tissue for histology. They are excised with a scalpel.
How fast does melanoma develop?
It varies: the superficial form can spread sideways for months or years, while the nodular form grows deep within weeks or months. A mole that has changed should therefore be shown to a doctor straight away.
Noticed suspicious skin changes or already diagnosed with melanoma? Do not lose time: send a request, and Clinics Direct medical coordinators will help you choose a clinic and obtain a diagnostic and treatment plan with prices, free of charge.
