Melanoma Treatment (PDQ®)
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General Information About MelanomaKey Points:
Melanoma is a disease in which malignant (cancer) cells form in
the skin cells called melanocytes (cells that color the skin).
Melanocytes are found
throughout the lower part of the epidermis. They make
pigment that gives skin its natural
color. When skin is exposed to the sun, melanocytes make more pigment,
causing the skin to tan, or darken.
Anatomy of the skin with melanocytes; drawing shows normal skin anatomy, including the epidermis, dermis, hair follicles, sweat glands, hair shafts, veins, arteries, fatty tissue, nerves, lymph vessels, oil glands, and subcutaneous tissue. The pullout shows a close-up of the squamous cell and basal cell layers of the epidermis above the dermis with blood vessels. Melanin is shown in the cells. A melanocyte is shown in the layer of basal cells at the deepest part of the epidermis.
The skin is the body’s largest organ. It protects against heat,
sunlight, injury, and infection. The
skin has 2 main layers: the epidermis (upper or outer layer) and the
dermis (lower or inner layer).
There are 3 types of skin cancer:
When melanoma starts in the skin, the disease is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips). This PDQ summary is about cutaneous (skin) melanoma and melanoma that affects the mucous membranes. When melanoma occurs in the eye, it is called intraocular or ocular melanoma. (See the PDQ summary on Intraocular (Eye) Melanoma
Treatment for more information.)
Melanoma is more aggressive than basal cell skin cancer or squamous
cell skin cancer. (See the PDQ summary on
Skin Cancer Treatment
for more information on basal cell and squamous cell skin cancer.)
Melanoma can occur anywhere on the body.
melanoma is often found on the trunk (the area from the shoulders to the hips)
or the head and neck. In women, melanoma forms most often on the arms and legs.
Melanoma is most common in adults, but it is sometimes found in children and
adolescents. See the PDQ summary on Unusual Cancers of Childhood for more information on melanoma in children and adolescents.)
Unusual moles, exposure to sunlight, and health history can
affect the risk of melanoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for melanoma include the
- Having a fair complexion, which includes the following:
- Fair skin that freckles and burns easily, does not tan, or tans poorly.
- Blue or green or other light-colored eyes.
- Red or blond hair.
- Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
- Having a history of many blistering sunburns, especially as a child or teenager.
- Having several large or many small moles.
- Having a family history of unusual moles (atypical nevussyndrome).
- Having a family or personal history of melanoma.
- Being white.
Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.
Possible signs of melanoma include a change in the appearance
of a mole or pigmented area.
These and other symptoms may be caused by melanoma. Other conditions may cause the same symptoms. Check with your doctor if you have any of the following problems:
- A mole that:
- changes in size, shape, or color.
- has irregular edges or borders.
- is more than one color.
- is asymmetrical (if the mole is divided in half, the 2
halves are different in size or shape).
- oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through).
- A change in pigmented (colored) skin.
- Satellite moles (new moles that grow near an existing
For pictures and descriptions of common moles and melanoma, see Common Moles, Dysplastic Nevi, and Risk of Melanoma.
Tests that examine the skin are used to detect (find) and
If a mole or pigmented area of the skin changes or looks abnormal,
the following tests and procedures can help find and diagnose
- Skin exam: A doctor or nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color,
size, shape, or texture.
- Biopsy: The removal of as much of the abnormal mole or lesion as possible. A pathologist looks at the tissue under a microscope to check for cancer cells. It can be hard to tell the difference between a colored mole and an early melanoma lesion. Patients may want to have their biopsy sample checked by a second pathologist.
A biopsy should be done on any abnormal areas of the skin. These areas should not be shaved off or
cauterized (destroyed with a hot
instrument, an electric current, or a caustic substance).
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on
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- The thickness of the tumor and where it is in the body.
- How quickly the cancer cells are dividing.
- Whether there was bleeding or ulceration at the primary site.
- Whether cancer has spread to the lymph nodes or to other places in the body.
- The number of places cancer has spread to in the body and the level of lactate dehydrogenate (LDH) in the blood.
- The patient’s
Stages of MelanomaKey Points:
After melanoma has been diagnosed, tests are done to find out
if cancer cells have spread within the skin or to other parts of the body.
The process used to find out whether cancer has spread within the skin or to other parts
of the body is called staging. The
information gathered from the staging process determines the stage of the
disease. It is important to know the stage in order to plan treatment. Talk with your doctor about what the stage of your cancer is.
The following tests and procedures may be used in the staging
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Wide local excision: A surgical procedure to remove some of the normal tissue around the area where abnormal tissue was removed. A pathologist then looks at the tissue under a microscope to check for cancer cells.
- Lymph node
mapping and sentinel lymph node
biopsy: Procedures in which a radioactive substance and/or blue dye is injected
near the tumor. The substance or dye flows through lymphducts to the
sentinel node or nodes (the first
lymph node or nodes where cancer
cells are likely to have spread). The surgeon removes only the nodes
with the radioactive substance or dye. A pathologist views a sample of tissue under a microscope to check for cancer cells. If no cancer cells are found, it may not be necessary to remove more nodes.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma,
pictures may be taken of the chest, abdomen, and pelvis.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- PET scan (positron
emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for an enzyme called lactate dehydrogenase (LDH). LDH levels that are higher than normal may be a sign of melanoma.
The results of these tests are viewed together with the results of
the tumor biopsy to find out the stage of the melanoma.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The method used to stage melanoma is based mainly on the thickness of the tumor and whether cancer has spread to lymph nodes or other parts of the body.
The staging system is based on the following:
- The thickness of the tumor. The thickness is described using the Breslow scale.
- Whether the tumor is ulcerated (has broken the skin).
- Whether the tumor has spread to the lymph nodes and if the lymph nodes are joined together (matted).
- Whether the tumor has spread to other parts of the body.
The following stages are used for melanoma:
Stage 0 (Melanoma in Situ)
Stage 0 melanoma in situ; drawing shows skin anatomy with an abnormal area on the surface of the skin. Both normal and abnormal melanocytes and melanin are shown in the epidermis (outer layer of the skin). Also shown are the dermis (inner layer of the skin) and the subcutaneous tissue below the dermis.
In stage 0, abnormalmelanocytes are found in the
These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.
Millimeters; drawing shows millimeters (mm) using everyday objects. A sharp pencil point shows 1 mm, a new crayon point shows 2 mm, and a new pencil-top eraser shows 5 mm.
Two-panel drawing of stage I melanoma. The first panel shows a stage IA tumor that is not more than 1 millimeter thick, with no ulceration (break in the skin). The second panel shows two stage IB tumors. One tumor is not more than 1 millimeter thick, with ulceration, and the other tumor is more than 1 but not more than 2 millimeters thick, with no ulceration. Also shown are the epidermis (outer layer of the skin), the dermis (inner layer of the skin), and the subcutaneous tissue below the dermis.
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
Three-panel drawing of stage II melanoma. The left panel shows two stage IIA tumors. One tumor is more than 1 but not more than 2 millimeters thick, with ulceration (break in the skin); the other tumor is more than 2 but not more than 4 millimeters thick, with no ulceration. The right panel shows two stage IIB tumors. One tumor is more than 2 but not more than 4 millimeters thick, with ulceration; the other tumor is more than 4 millimeters thick, with no ulceration. The bottom panel shows a stage IIC tumor that is more than 4 millimeters thick, with ulceration. Also shown are the epidermis (outer layer of the skin), the dermis (inner layer of the skin), and the subcutaneous tissue below the dermis.
Stage II is divided
into stages IIA, IIB, and IIC.
Stage III melanoma; drawing shows a primary tumor on the lower arm. In the top inset, cancer is shown (a) in lymph nodes near a blood vessel. In the bottom inset, cancer is shown (b) in lymph nodes that are joined together (matted), (c) in a lymph vessel, and (d) not more than 2 centimeters away from the primary tumor.
In stage III, the
tumor may be any thickness, with or without ulceration. One or more of the following is true:
- Cancer has spread to one or more lymph nodes.
- Lymph nodes may be joined together (matted).
- Cancer may be in a lymph vessel between the primary tumor and nearby lymph nodes.
- Very small tumors may be found on or under the skin, not more than 2 centimeters away from where the cancer first started.
Stage IV melanoma; drawing shows that the primary tumor has spread to other parts of the body, such as the brain, lung, liver, lymph nodes, small intestine, or bone. The pullout shows cancer in the lymph nodes, lymph vessels, and blood vessel.
In stage IV, the cancer has spread to other places in the body, such as the lung, liver, brain, bone, soft tissue, or gastrointestinal (GI) tract. Cancer may have spread to places in the skin far away from where it first started.[Back to top]
Recurrentmelanoma is cancer that has recurred
(come back) after it has been treated. The cancer may come back in the area where it first started or in other parts of the body, such as the lungs or liver.[Back to top]
Treatment Option OverviewKey Points:
There are different types of treatment for patients with
Different types of treatment are available for patients with
melanoma. Some treatments are
standard (the currently used treatment), and some are being tested in
clinical trials. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Five types of standard treatment are used:
Surgery to remove the
tumor is the primary treatment of
all stages of melanoma. The doctor
may remove the tumor using the following operations:
Skin grafting (taking
skin from another part of the body to replace the skin that is removed) may be
done to cover the wound caused by surgery.
Even if the doctor removes all the melanoma that can be seen at
the time of the operation, some patients may be offered
chemotherapy after surgery to kill
any cancer cells that are left. Chemotherapy given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
One type of regional chemotherapy is hyperthermicisolated limb perfusion. With this method, anticancer drugs go directly to the arm or leg the cancer is in. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drugs is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
See Drugs Approved for Melanoma for more information.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiationtherapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
Interferon and interleukin-2 (IL-2) are types of biologic therapy used to treat melanoma. Interferon affects the division of cancer cells and can slow tumor growth. IL-2 boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells.
Tumor necrosis factor (TNF) therapy is a type of biologic therapy used with other treatments for melanoma. TNF is a protein made by white blood cells in response to an antigen or infection. Tumor necrosis factor can be made in the laboratory and used as a treatment to kill cancer cells.
See Drugs Approved for Melanoma for more information.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. The following types of targeted therapy are being used in the treatment of melanoma:
- Monoclonal antibody therapy: A cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used with chemotherapy as adjuvant therapy.
Ipilimumab is a monoclonal antibody used to treat melanoma.
- Signal transduction inhibitor therapy: A type of targeted therapy. Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Vemurafenib is a signal transduction inhibitor used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery.
- Oncolytic virus therapy: A type of targeted therapy that is being studied in the treatment of melanoma. Oncolytic virus therapy uses a virus that infects and breaks down cancer cells but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells.
- Angiogenesis inhibitors: A type of targeted therapy that is being studied in the treatment of melanoma. Angiogenesis inhibitors block the growth of new blood vessels. In cancer treatment, they may be given to prevent the growth of new blood vessels that tumors need to grow.
See Drugs Approved for Melanoma for more information.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI Web site
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.[Back to top]
Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.[Back to top]
Stage 0 (Melanoma in Situ)
Treatment of stage 0 is usually surgery to remove the area of abnormalcells and a small amount of normal tissue around it.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Stage I Melanoma
Treatment of stage I
melanoma may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Stage II Melanoma
Treatment of stage II melanoma may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Stage III Melanoma
Treatment of stage III melanoma that can be removed by surgery may include the following:
Treatment of stage III melanoma that cannot be removed by surgery may include the following:
Treatments that are being studied in clinical trials for stage III melanoma include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Stage IV and Recurrent Melanoma
Treatment of stage IV and recurrentmelanoma may include the following:
Treatments that are being studied in clinical trials for stage IV and recurrent melanoma include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV melanoma and recurrent melanoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
To Learn More About Melanoma
For more information from the National Cancer Institute about melanoma, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:[Back to top]
Changes to This Summary (03/29/2013)
The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.