Melanoma (Skin Cancer) Causes, Types, Signs, Symptoms, Treatment, Prevention

Melanoma (Skin Cancer) Causes, Signs, Symptoms, Treatment, Prevention


General Information on Melanoma


Melanoma occurs when melanocytes (pigment cells) become malignant. Most pigment cells are in the skin; when melanoma starts in the skin, the disease is called cutaneous melanoma. Melanoma may also occur in the eye and is called ocular melanoma or intraocular melanoma. Rarely, melanoma may arise in the meninges, the digestive tract, lymph nodes, or other areas where melanocytes are found. Melanomas arising in areas other than the skin are not discussed in this booklet.

Melanoma can occur on any skin surface. In men, it is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the lower legs. Melanoma is rare in black people and others with dark skin. When it does develop in dark-skinned people, it tends to occur under the fingernails or toenails, or on the palms or soles. The chance of developing melanoma increases with age, but this disease affects people of all age groups. Melanoma is one of the most common cancers in young adults.

When melanoma spreads, cancer cells are also found in the lymph nodes (also called lymph glands). If the cancer has reached the lymph nodes, it may mean that cancer cells have spread to other parts of the body such as the liver, lungs, or brain. In such cases, the cancer cells in the new tumor are still melanoma cells, and the disease is called metastatic melanoma rather than liver, lung, or brain cancer.

Read more: Menetrier Disease Causes, Symptoms, Diagnosis, Treatment

What Is Melanoma?


Melanoma is a type of skin cancer. It begins in certain cells in the skin called melanocytes. To understand melanoma, it is helpful to know about the skin and about melanocytes -- what they do, how they grow, and what happens when they become cancerous.

The Skin


The skin is the body's largest organ. It protects against heat, sunlight, injury, and infection. It helps regulate body temperature, stores water and fat, and produces vitamin D. The skin has two main layers: the outer epidermis and the inner dermis.

The epidermis is mostly made up of flat, scalelike cells called squamous cells. Round cells called basal cells lie under the squamous cells in the epidermis. The lower part of the epidermis also contains melanocytes.

The dermis contains blood vessels, lymphatic vessels, hair follicles, and glands. Some of these glands produce sweat, which helps regulate body temperature, and some produce sebum, an oily substance that helps keep the skin from drying out. Sweat and sebum reach the skin's surface through tiny openings called pores.

Melanocytes and Moles


Melanocytes are found throughout the lower part of the epidermis. They produce melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes produce more pigment, causing the skin to tan, or darken.

Sometimes, clusters of melanocytes and surrounding tissue form benign (noncancerous) growths called moles. (Doctors also call a mole a nevus; the plural is nevi.) Moles are very common. Most people have between 10 and 40 of these flesh-colored, pink, tan, or brown areas on the skin. Moles can be flat or raised. They are usually round or oval and smaller than a pencil eraser. They may be present at birth or may appear later on -- usually before age 40. Moles generally grow or change only slightly over a long period of time. They tend to fade away in older people. When moles are surgically removed, they normally do not return.

Cancer


Cancer is a group of many different diseases that have some important things in common. They all begin in cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed, creating a mass of extra tissue. This mass is called a growth or tumor. Tumors can be benign or malignant.

Benign tumors are not cancer


They often can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most importantly, benign tumors are rarely a threat to life.

Malignant tumors are cancer


Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system (the tissues and organs that produce and store cells that fight infection and disease). This process, called metastasis, is how cancer spreads from the original tumor to form new tumors in other parts of the body. When cancer spreads (metastasizes) to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor.

What are the causes and risk factors for melanoma?


Individual sunburns do raise your risk of melanoma. However, slow daily sun exposure, even without burning, may also substantially raise your risk of skin cancer.

Factors that raise your risk for melanoma include:

  • Caucasian (white) ancestry
  • Fair skin, light hair, and light-colored eyes
  • A history of intense, intermittent sun exposure, especially in childhood
  • Many (more than 100) moles
  • Large, irregular, or "funny looking" moles
  • Close blood relatives -- parents, siblings, and children -- with melanoma
The presence of close (first-degree) family with melanoma is a high risk factor, although looking at all of melanoma, only 10% of cases run in families.

Who is at risk of melanoma?


Melanoma is most common in white skinned individuals, but it may rarely develop in those with dark skin as well. 

Melanoma can occur in adults of any age but is very rare in children.

The main risk factors for developing the most common type of melanoma (superficial spreading melanoma) include:

  • Increasing age (see above)
  • Previous invasive melanoma or melanoma in situ
  • Previous nonmelanoma skin cancer
  • Many melanocytic naevi (moles)
  • Multiple (>5) atypical naevi (funny-looking moles or moles that are histologically dysplastic)
  • Strong family history of melanoma with 2 or more first-degree relatives affected
  • Fair skin that burns easily
However these risk factors are not important for the less common types of melanoma.

How do I estimate my level of risk for melanoma?


The best way to know your risk level is to have a dermatologist perform a full body examination. That way you will find out whether the spots you have are moles and, if so, whether they are "funny looking" in the medical sense.

The medical term for such moles is "atypical." This is a somewhat confusing term, because among other things the criteria for defining it are not clear, and it's not certain that an atypical mole is necessarily precancerous. If you have such moles, your doctor may do a biopsy in order to counsel you about the need for surveillance or further testing.

Sometimes, you learn at a routine skin evaluation that you do not necessarily need annual routine checkups. In other situations, your doctor may recommend regular checks at six-month or yearly intervals.

How does a melanoma grow?


Cancers proliferate at an uncontrolled rate because of abnormalities in the genes that control cell growth. Further genetic changes promote invasion into surrounding tissue. Melanoma is now thought to begin as uncontrolled proliferation of transformed melanocytic stem cells.

Superficial forms of melanoma spread out within the outside layer of skin (the epidermis). A pathologist may report this as the radial or horizontal growth phase. If all the melanoma cells are confined to the epidermis, it is melanoma in situ. Lentigo maligna is a special kind of melanoma in situ that occurs around hair follicles on the sun damaged skin of the face or neck. Melanoma in situ is always cured by excision because it has no potential to spread round the body.

When the cancerous cells have grown through the basement membrane into the deeper layer of the skin (the dermis), it is known as invasive melanoma. The pathologist may state that the tumour has a vertical growth phase, which is potentially more dangerous than the horizontal growth phase. Nodular melanoma appears to be invasive from the beginning, and has little or no relationship to sun exposure.

Once the melanoma cells have reached the dermis, they may spread to other tissues via the lymphatic system to the local lymph nodes or via the blood stream to other organs such as the lungs or brain. This is known as metastatic disease or secondary spread. The chance of this happening mainly depends on how deep the cells have penetrated into the skin. So early detection of melanoma is vital.

Where do you find melanomas?


Melanoma can arise from otherwise normal appearing skin (75% of melanomas) or from within a mole or freckle, which starts to grow larger and change in appearance. Precursor lesions include:

  • Benign melanocytic naevus (normal mole)
  • Atypical or dysplastic naevus (funny-looking mole)
  • Atypical lentiginous junctional naevus (freckle in heavily sun damaged skin)
  • Congenital melanocytic naevus (brown birthmark)
Melanomas can occur anywhere on the body, not only in areas that get a lot of sun. The most common site in men is the back (around 40% of melanomas), and the most common site in women is the leg (also around 40%).

Although melanoma usually starts as a skin lesion, it can also rarely grow on mucous membranes such as the lips or genitals. Occasionally it occurs in other parts of the body such as the eye, brain, mouth or vagina.

Signs and Symptoms of Melanoma


Often, the first sign of melanoma is a change in the size, shape, color, or feel of an existing mole. Most melanomas have a black or blue-black area. Melanoma also may appear as a new, black, abnormal, or "ugly-looking" mole.

Early melanomas may be found when a pre-existing mole changes slightly -- such as forming a new black area. Other frequent findings are newly formed fine scales or itching in a mole. In more advanced melanoma, the texture of the mole may change. For example, it may become hard or lumpy. Although melanomas may feel different and more advanced tumors may itch, ooze, or bleed, melanomas usually do not cause pain.

Melanoma can be cured if it is diagnosed and treated when the tumor is thin and has not deeply invaded the skin. However, if a melanoma is not removed at its early stages, cancer cells may grow downward from the skin surface, invading healthy tissue. When a melanoma becomes thick and deep, the disease often spreads to other parts of the body and is difficult to control.

A skin examination is often part of a routine checkup by a doctor, nurse specialist, or nurse practitioner. People also can check their own skin for new growths or other changes. Changes in the skin or a mole should be reported to the doctor or nurse without delay. The person may be referred to a dermatologist, a doctor who specializes in diseases of the skin.

People who have had melanoma have a high risk of developing a new melanoma. Also, those with relatives who have had this disease have an increased risk. Doctors may advise people at risk to check their skin regularly and to have regular skin exams by a doctor or nurse specialist.

Some people have certain abnormal-looking moles, called dysplastic nevi or atypical moles, that may be more likely than normal moles to develop into melanoma. Most people with dysplastic nevi have just a few of these abnormal moles; others have many. They and their doctor should examine these moles regularly to watch for changes.

Dysplastic nevi often look very much like melanoma. Doctors with special training in skin diseases are in the best position to decide whether an abnormal-looking mole should be closely watched or should be removed and checked for cancer.

In some families, many members have a large number of dysplastic nevi, and some have had melanoma. Members of these families have a very high risk for melanoma. Doctors often recommend that they have frequent checkups (every 3 to 6 months) so that any problems can be detected early. The doctor may take pictures of a person's skin to help in detecting any changes that occur.

What are the types of melanoma?


The main types of melanoma are:

Superficial spreading melanoma


This type accounts for about 70% of all cases of melanoma. The most common locations are the legs of women and the backs of men, and they occur most commonly between the ages of 30 and 50. (Note: Melanomas can occur in other locations and at other ages as well.) These melanomas are often barely raised and have a variety of colors. Such melanomas evolve over one to five years and can be readily caught at an early stage if they are detected and removed.

Nodular melanoma


About 20% of melanomas begin as deeper, blue-black to purplish lumps. They may evolve faster and may also be more likely to spread.

Lentigo maligna


Unlike other forms of melanoma, lentigo maligna tends to occur on places like the face, which are exposed to the sun constantly rather than intermittently. Lentigo maligna looks like a large, irregularly shaped or colored freckle and develops slowly. It may take many years to evolve into a more dangerous melanoma.
There are also other rarer forms of melanoma that may occur, for example, under the nails, on the palms and soles, in the eye, or sometimes even inside the body.

How is melanoma diagnosed?


Most doctors diagnose melanoma by examining the spot causing concern and doing a biopsy. A skin biopsy refers to removing all or part of the skin spot under local anesthesia and sending the specimen to a pathologist for analysis.

The biopsy report may show any of the following:

  • a totally benign condition requiring no further treatment, such as a regular mole
  • an atypical mole which, depending on the judgment of the doctor and the pathologist, may need a conservative removal (taking off a little bit of normal skin all around just to make sure that the spot is completely out)
  • a melanoma requiring surgery.
Some doctors are skilled in a clinical technique called epiluminescence microscopy (also called dermatoscopy). They cover a suspicious spot with oil and examine it with a brightly lit magnifying instrument. The gold standard for a solid diagnosis, however, remains a skin biopsy.

What is the treatment for melanoma?


After diagnosis and staging, the doctor develops a treatment plan to fit each patient's needs. Treatment for melanoma depends on the extent of the disease, the patient's age and general health, as well as other factors.

In general, melanoma is treated by surgery alone. Doctors have learned that surgery does not need to be as extensive as was thought years ago. When treating many early melanomas, for instance, surgeons only remove 1 centimeter (less than ½ inch) of the normal tissue around the melanoma. Deeper and more advanced cancers may need more extensive surgery.

Depending on various considerations (tumor thickness, body location, age, etc.), the removal of nearby lymph glands may be recommended. For advanced disease, such as when the melanoma has spread to other parts of the body, treatments like immunotherapy are sometimes recommended.

People with melanoma are often treated by a team of specialists, which may include a dermatologist, surgeon, medical oncologist, and plastic surgeon. The standard treatment for melanoma is surgery; in some cases, doctors may also use chemotherapy, biological therapy, or radiation therapy. The doctors may decide to use one treatment method or a combination of methods.

Some patients take part in a clinical trial, which is a research study using new treatment methods. Such trials are designed to improve cancer treatment.

Methods of Treatment of Melanoma (Skin Cancer) 


Surgery to remove (excise) a melanoma is the standard treatment for this disease. It is necessary to remove not only the tumor but also some normal tissue around it in order to minimize the chance that any cancer will be left in the area.

The width and depth of surrounding skin that needs to be removed depends on the thickness of the melanoma and how deeply it has invaded the skin. In cases in which the melanoma is very thin, enough tissue is often removed during the biopsy, and no further surgery is necessary. If the melanoma was not completely removed during the biopsy, the doctor takes out the remaining tumor. In most cases, additional surgery is performed to remove normal-looking tissue around the tumor (called the margin) to make sure all melanoma cells are removed. This is necessary, even for thin melanomas. For thick melanomas, it may be necessary to do a wider excision to take out a larger margin of tissue.

If a large area of tissue is removed, a skin graft may be done at the same time. For this procedure, the doctor uses skin from another part of the body to replace the skin that was removed.

Lymph nodes near the tumor may be removed during surgery because cancer can spread through the lymphatic system. If the pathologist finds cancer cells in the lymph nodes, it may mean that the disease has spread to other parts of the body.

Surgery is generally not effective in controlling melanoma that is known to have spread to other parts of the body. In such cases, doctors may use other methods of treatment, such as chemotherapy, biological therapy, radiation therapy, or a combination of these methods. When therapy is given after surgery (primary therapy) to remove all cancerous tissue, the treatment is called adjuvant therapy. The goal of adjuvant therapy is to kill any undetected cancer cells that may remain in the body.

Chemotherapy is the use of drugs to kill cancer cells. It is generally a systemic therapy, meaning that it can affect cancer cells throughout the body. In chemotherapy, one or more anticancer drugs are given by mouth or by injection into a blood vessel (intravenous). Either way, the drugs enter the bloodstream and travel through the body.

Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Usually a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.

One method of giving chemotherapy drugs currently under investigation is called limb perfusion. It is being tested for use when melanoma occurs only on an arm or leg. In limb perfusion the flow of blood to and from the limb is stopped for a while with a tourniquet. Anticancer drugs are then put into the blood of the limb. The patient receives high doses of drugs directly into the area where the melanoma occurred. Since most of the anticancer drugs remain in one limb, limb perfusion is not truly systemic therapy.

Biological therapy (also called immunotherapy) is a form of treatment that uses the body's immune system, either directly or indirectly, to fight cancer or to lessen side effects caused by some cancer treatments. Biological therapy is also a systemic therapy and involves the use of substances called biological response modifiers (BRMs). The body normally produces these substances in small amounts in response to infection and disease. Using modern laboratory techniques, scientists can produce BRMs in large amounts for use in cancer treatment. In some cases, biological therapy given after surgery can help prevent melanoma from recurring. For patients with metastatic melanoma or a high risk of recurrence, interferon-alfa and interleukin-2 (also called aldesleukin) may be recommended after surgery. Colony-stimulating factors and tumor vaccines are examples of other BRMs under study.

In some cases, radiation therapy (also called radiotherapy) is used to relieve some of the symptoms caused by melanoma. Radiation therapy is the use of high-energy rays to kill cancer cells. Radiation therapy is a local therapy; it affects cells only in the treated area. Radiation therapy is most commonly used to help control melanoma that has spread to the brain, bones, and other parts of the body.

Preparing for Melanoma Treatment


Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the doctor. Often, it helps to make a list of questions. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor -- to take part in the discussion, to take notes, or just to listen.

These are some questions a patient may want to ask the doctor before treatment begins:

  • What is my diagnosis?
  • What is the stage of the disease?
  • What are the treatment choices? Which do you recommend? Why?
  • What are the chances that the treatment will be successful?
  • How will we know if the treatment is working?
  • How long will the treatment last?
  • What can I do to take care of myself during treatment?
  • What new treatments are being studied? Would a clinical trial be appropriate for me?
  • What are the risks and possible side effects of each treatment?
  • How will I feel after the operation?
  • If I have pain, how can it be controlled?
  • Will I need more treatment after surgery?
  • Will I need a skin graft or plastic surgery? Will there be a scar?
  • Will treatment affect my normal activities? If so, for how long?
  • How often will I need checkups?
  • What is the treatment likely to cost?

Patients do not need to ask all their questions or remember all the answers at one time. They will have other chances to ask the doctor to explain things and to get more information.

Clinical Trials


Many people with melanoma take part in clinical trials (research studies). Doctors conduct clinical trials to learn about the effectiveness and side effects of new treatments. In some trials, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the standard therapy to another group; or they may compare one standard treatment with another. Research like this has led to significant advances in the treatment of melanoma. Each achievement brings researchers closer to the eventual control of melanoma.

A new procedure under study, called sentinel lymph node biopsy, may eventually reduce the number of lymph nodes that need to be removed for biopsy and possibly prevent or lessen the severity of lymphedema (build up of excess lymph in tissue that causes swelling). In this procedure, either a blue dye or a small amount of radioactive material is injected near the area where the tumor was. This material flows into the sentinel lymph node(s) (the first lymph node(s) that the cancer is likely to spread to from the primary tumor). A surgeon then looks for the dye or uses a scanner to find the sentinel lymph node(s) and removes it for examination by a pathologist. If the sentinel lymph node(s) is positive for cancer cells, then the rest of the surrounding lymph nodes are usually removed; if it is negative, the remaining lymph nodes may not need to be removed.

Doctors are also studying new ways of giving chemotherapy, biological therapies, and radiation therapy; new drugs and drug combinations; and new ways of combining various types of treatment. Some trials are designed to explore ways to reduce the side effects of treatment and to improve the quality of life.

People who take part in these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science. While clinical trials may pose some risks for the people who take part, each study takes steps to protect patients. Patients who are interested in taking part in a clinical trial should talk with their doctor.

Another way to learn about clinical trials is through PDQ , a cancer information database developed by the National Cancer Institute. PDQ contains information about cancer treatment and about clinical trials in progress throughout the country. The Cancer Information Service can provide PDQ information to patients and the public.

Side Effects of Melanoma Treatment


Doctors plan treatment to keep side effects to a minimum, but it is hard to limit the effects of therapy so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes side effects.

The side effects of cancer treatment depend mainly on the type and extent of the treatment. Side effects may not be the same for everyone, and they may change from one treatment to the next. Doctors and nurses can explain the possible side effects of treatment, and they can help relieve symptoms that may occur during and after treatment.

Surgery


The side effects of surgery depend mainly on the size and location of the tumor and the extent of the operation. Although patients may be uncomfortable during the first few days after surgery, this pain can be controlled with medicine. People should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for awhile. The length of time it takes to recover from an operation varies for each patient.

Scarring may also be a concern for some patients. To avoid causing large scars, doctors remove as little tissue as they can without increasing the chance of recurrence. In general, the scar from surgery to remove an early stage melanoma is a small line (often 1 to 2 inches long), and it fades with time. How noticeable the scar is depends on where the melanoma was located, how well the person heals, and whether the person develops raised scars called keloids. When a tumor is large and thick, more surrounding skin and other tissue (including muscle) are removed. Although skin grafts reduce scarring from the removal of large growths, these scars will still be quite noticeable.

Surgery to remove the lymph nodes from the underarm or groin may damage the lymphatic system and slow the flow of lymph in the arm or leg. Lymph may build up in a limb and cause swelling (lymphedema). The doctor or nurse can suggest exercises or other ways to reduce swelling if it becomes a problem. Also, it is harder for the body to fight infection in a limb after nearby lymph nodes have been removed, so the patient will need to protect the arm or leg from cuts, scratches, bruises, or burns that may lead to infection. If an infection does develop, the patient should see the doctor right away.

Chemotherapy


The side effects of chemotherapy depend mainly on the drugs and the doses received. In addition, as with other types of treatment, side effects vary from person to person. Generally, anticancer drugs affect cells that divide rapidly. In addition to cancer cells, these include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected, people are more likely to get infections, may bruise or bleed easily, and may feel unusually weak or tired. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, people may lose their hair and may have other side effects, such as poor appetite, nausea and vomiting, or mouth and lip sores. These side effects generally go away gradually during the recovery periods between treatments or after treatment is over.

Biological therapy


The side effects caused by biological therapy vary with the type of treatment. These treatments may cause flu-like symptoms, such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients may also bleed or bruise easily, get a skin rash, or have swelling. These problems can be severe, but they go away after treatment stops.

Radiation therapy


The side effects of radiation therapy depend on the amount of radiation given and the area being treated. Side effects that may occur during treatment include fatigue and hair loss in the treated area. Although the side effects of radiation therapy can be unpleasant, the doctor can usually treat or control them. It also helps to know that, in most cases, side effects are not permanent.

Nutrition for People with Cancer


Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and regain strength. This often helps people feel better and have more energy.

Some people with cancer find it hard to eat well because they may lose their appetite. In addition, common side effects of treatment, such as nausea, vomiting, or mouth sores, can make eating difficult. Often, foods taste different. Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired.

Doctors, nurses, and dietitians can offer advice on how to get enough calories and protein during cancer treatment.

Support for People with Melanoma (Skin Cancer)


Living with a serious disease is not easy. People with cancer and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services.

Friends and relatives can be very supportive. It also helps many patients to discuss their concerns with others who have cancer. Cancer patients often get together in support groups, where they can share what they have learned about coping with cancer and the effects of treatment. It is important to keep in mind, however, that each person is different. Treatments and ways of dealing with cancer that work for one person may not be right for another -- even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.

Cancer patients may worry about holding their jobs, caring for their families, keeping up with daily activities, or starting new relationships. Concerns about tests, treatments, hospital stays, and medical bills are also common. The doctor can answer questions about treatment, working, outlook (prognosis), and the activity level people may be able to manage. Meeting with a nurse, social worker, counselor, or member of the clergy can be helpful to people who want to talk about their feelings or discuss their concerns.

What methods are available to help prevent melanoma?


Reducing sun exposure


Avoidance of sun exposure is the best means of helping to prevent melanoma, followed by wearing hats and tightly woven clothing, and then followed by broad-spectrum waterproof sunscreens applied liberally and often. There has been some controversy about the extent to which sunscreens protect against melanoma. The consensus among dermatologists is that sunscreens are at least partially helpful and are certainly preferable to unprotected sun exposure. (Despite sensational articles in the popular press, there is no credible evidence that sunscreens can cause melanoma.)

Early detection


Get your skin checked at least once. Then, if it is recommended, have your skin checked on a regular basis. The American Academy of Dermatology sponsors free skin cancer screening clinics every May all over the country. Special "Pigmented Lesion Clinics" have also been established in many medical centers to permit close clinical and photographic follow-up of patients at high risk. In most areas, these clinics are only available to patients who have been referred to them by a concerned dermatologist.

Screening of high-risk individuals


Anyone at high risk, such as anyone with a close relative who has melanoma, should be screened by a doctor for melanoma.

Recovery and Outlook


It is natural for anyone facing cancer to be concerned about what the future holds. Understanding the nature of cancer and what to expect can help patients and their loved ones plan treatment, anticipate lifestyle changes, and make quality of life and financial decisions.

Cancer patients frequently ask their doctors, "What is my prognosis?" Prognosis is a prediction of the future course and outcome of a disease and an indication of the likelihood of recovery. When doctors discuss a patient's prognosis, they are attempting to project what is likely to occur for that individual patient.

Sometimes people use statistics they have heard to try to figure out their own chances of being cured. However, statistics reflect the experience of large groups of patients; they cannot be used to predict what will happen to a particular patient because no two patients are alike. The prognosis for a person with melanoma can be affected by many factors, particularly the stage of the cancer and the patient's general health and response to treatment. The doctor who is most familiar with the patient's situation is in the best position to help interpret statistics and discuss the patient's prognosis.

When doctors talk about surviving cancer, they may use the term remission rather than cure. Although many people with melanoma are successfully treated, doctors use this term because cancer can return. Many patients find it helpful to discuss the possibility of recurrence with the doctor.