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Melanoma



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What is melanoma?

Melanoma is a type of skin cancer which usually occurs on the parts of the body that have been overexposed to the sun. Rare melanomas can occur in parts of the skin or body that have never been exposed to the sun.

Melanoma is the fourth most common cancer diagnosed in Australia, which along with New Zealand has the world's highest incidence rate for melanoma. Melanoma is more commonly diagnosed in men than women. The risk of being diagnosed with melanoma by age 85 is 1 in 14 for men compared to 1 in 24 for women.1 

In 2013, 12,744 new cases of melanoma were diagnosed in Australia, accounting for nearly one in ten cancer diagnoses.

In Australia in 2014, there were 1467 deaths due to melanoma. The five-year survival rate for people diagnosed with melanoma is 90%.


Melanoma symptoms

Often melanoma has no symptoms, however, the first sign is generally a change in an existing mole or the appearance of a new spot. These changes can include:

  • colour – a mole may change in colour or have different colour shades or become blotchy
  • size – a mole may appear to get bigger
  • shape – a mole may have in irregular border or may increase in height
  • elevation – the mole may develop a raised area
  • itching or bleeding.

Other symptoms include dark areas under nails or on membranes lining the mouth, vagina or anus.

New moles and spots will appear and change during childhood, adolescence and during pregnancy and this is normal. However, adults who develop new spots or moles should have them examined by their doctor. 


Causes of melanoma

Melanoma risk increases with exposure to UV radiation, particularly with episodes of sunburn (especially during childhood).

Melanoma risk is increased for people who have:

  • unprotected sun exposure
  • increased numbers of unusual moles (dysplastic naevi)
  • depressed immune systems
  • a family history of melanoma in a first degree relative
  • fair skin, a tendency to burn rather than tan, freckles, light eye colour, light or red hair colour
  • had a previous melanoma or non-melanoma skin cancer.
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Diagnosis for melanoma

If you have a suspicious spot or mole, your doctor may examine you and use a dermascope (magnifying instrument). The ABCDE method is used to help identify symptoms and make a diagnosis:

  • A - Asymmetry, irregular
  • B - Border, uneven
  • C - Colour
  • D - Diameter (usually over 6mm),
  • E - Evolving (changing and growing).

If the doctor suspects melanoma, a biopsy may be carried out. This may be done by your GP or you may be referred to another specialist.


Treatment for melanoma

Staging

The most important feature of a melanoma in predicting its outcome is its thickness (stage 0 is less than 0.1mm, stage I less than 2mm, stage II greater than 2mm, stage III spread to lymph nodes and stage IV distant spread). The presence of ulceration also predicts a poor outcome. If distant spread is suspected, CT scans of the chest, abdomen and pelvis are performed. The blood test LDH can sometimes be useful to assess metastatic disease.

Early-stage melanoma

Surgery can be curative for thin melanomas and requires that the melanoma be removed with at least 1–2cm of normal skin around it. If the draining lymph nodes are involved they are removed.

If the melanoma has spread to the lymph nodes, you will have a lymph node dissection or lymphadenectomy to remove them. 

Advanced melanoma

For thick melanomas some cancer centres offer high dose interferon after surgery, however many offer clinical trials of vaccines because there is no routine therapy mandated. Surgery should be the mainstay of treating relapsed melanoma if it is possible to remove all of the disease.

Chemotherapy has recently been shown to be of benefit to patients with advanced melanoma. 

Therapy for advanced disease can involve targeted therapy with a BRAF inhibitor in combination with a MEK inhibitor if your tumour has an activating BRAF mutation or immunotherapy which has activity in both BRAF mutation positive and negative tumours. The oncologist involved in your care may discuss with you which therapies are appropriate.

Radiotherapy may be of benefit in treating some forms of melanoma. It can also be used to palliate local symptoms.

Palliative care

In some cases of melanoma cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of melanoma, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

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Screening for melanoma

There is no organised screening program for melanoma. However, individuals at high risk of melanoma should be taught to check their skin for irregular or changing lesions, and have annual checks by a dermatologist.

Download Cancer Council's skin cancer identification poster to help identify potential skin cancers.

Melanoma poster


Prognosis for melanoma

An individual’s prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis. 


Preventing melanoma  

Avoid sunburn by minimising sun exposure when the SunSmart UV Index exceeds 3 and especially in the middle of the day when UV levels are most intense. Seek shade, wear a hat that covers the head, neck and ears, wear sun protective clothing and close-fitting sunglasses, and wear an SPF30+ sunscreen. Avoid using solariums (tanning salons).


Source

Understanding Melanoma, Cancer Council Australia © 2017. Last medical review of source booklet, January 2017.

Optimal Care Pathways, developed by Cancer Council Victoria.

Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) books: Melanoma. Canberra: AIHW.

Australian Institute of Health and Welfare (AIHW) 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW.

1) Excluding non-melanoma skin cancer, which is the most commonly diagnosed cancer according to general practice and hospitals data, however there is no reporting of cases to cancer registries.

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For more information

Sources

  • Australian Institute of Health and Welfare (AIHW) 2012. ACIM (Australian Cancer Incidence and Mortality) Books. AIHW: Canberra.
  • Australian Institute of Health and Welfare & Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW.
  • Australian Bureau of Statistics. Causes of death 2011. 3303.0. Commonwealth of Australia:Canberra, Australia 2012


This page was last updated on: Tuesday, March 19, 2013