What is it?

Last year in the United States, more than 38,000 people were diagnosed with malignant melanoma. Each year 7,000 people die from this form of cancer. Malignant melanoma is less common than other skin cancers (basal cell and squamous cell carcinomas), but it is potentially more lethal. The incidence of this tumor has climbed 4% per year since 1973 and the lifetime risk for developing melanoma is rising as well; 1 in 75 change by the year 2000. However, survival rates have also increased over the years which is attributed to an increased awareness of the public and medical communities with earlier recognition and subsequent treatment.

What causes it?

Trouble begins in cells called melanocytes when an unknown collaboration between defective genes and undefined environmental factors spurs the growth of cancerous cells. Although sunlight has been implicated in the development of this growth, the cause is less certain than that of other skin cancers.

What to look for?

Any pigmented lesion that changes color, diameter or size, shape or consistency, demonstrates change in the surrounding skin, or is symptomatic (tender, itchy, infected or bleeding) must be viewed as suspicious and needs to be evaluated by a physician.

Look for the warning signs in pigmented [colored] lesions of the skin:
Asymmetry (one half unlike the other half)
Border irregularity (scalloped or poorly circumscribed border)
Color (varied from one week to another; shades of tan/brown; black; sometimes white, red or blue)
Diameter (larger than 6mm, the diameter of a pencil eraser)

It is recommended to examine your body regularly, as often as once a month. Be sure to include the scalp, back of the ears and neck, and other hard-to-see areas. (A full-length mirror and hand-held mirror can be very helpful.) If you observe any one of these warning signs or other changes in your skin, or unusual growth, consult your physician immediately.


After the physician’s exam, the diagnosis is confirmed with a biopsy ; a small piece of tissue removed and examined in the laboratory under a microscope. If tumor cells are present, treatment (usually surgery) is required. In the case of melanoma, the biopsy not only reveals the diagnosis but also allows the physician to evaluate how deep the growth extends into tissue. This has very important implications as far as prognosis for survival and treatment options. Surgery remains the treatment of choice for malignant melanoma. Radiation, chemotherapy, and immunotherapy are generally reserved for patients with distant spreading [metastatic] malignant melanoma or those with a poor prognosis, as an adjuvant to surgery.

The only way to cure a primary melanoma is to excise it entirely before it has an opportunity to spread. In fact, patients with minimum and low-risk melanomas (based on depth or thickness of involvement) generally do well without any further treatment. Once the tumor spreads beyond the skin, care focuses on keeping patients as comfortable as possible for as long as possible. Treatment should always be guided by an expert in melanoma.

Long–Term Follow-up

Any patient who’s had melanoma needs to be seen regularly for a skin check and physical examination. Appointments should be scheduled every 3 months in the first year after an occurrence, and every six months thereafter. Patients who have had very thin melanomas can probably be examined on a yearly basis after several uneventful years. Again, the objective is to make sure there are no signs of distant spread [metastatic] and no new tumors.