Melanoma is a serious form of skin cancer. It happens when normal cells in the skin change into abnormal cells and grow out of control.
Melanoma can occur anywhere on the skin, including the back and other hard-to-see areas. It can also occur on the skin lining the mouth, nose, and genitals. When it is not treated, melanoma can spread to organs inside the body. Melanoma can run in families.
Melanoma is a form of cancer that develops in the cells (melanocytes) that make our skin color. Melanoma is the sixth most common cancer in the United States, and the number of melanoma cases diagnosed annually is increasing faster than for any other cancer.
Melanoma generally starts as a single tumor or lesion. Cancer cells can then spread to nearby lymph nodes and/or distant sites throughout the body. Once melanoma spreads to distant locations, it is called advanced or metastatic. Rarely, melanoma is diagnosed when a person presents with distant metastases, and no primary site on the skin or elsewhere can be found.
After melanoma is diagnosed, the next step is to determine the cancer’s stage, which is based upon the thickness of the tumor, the extent of its spread, and its aggressiveness. Staging is important to determine the most appropriate treatment.
Most people with melanoma have one or more of the following treatments depending on the stage:
- Surgery – Melanoma is usually treated with surgery to remove the cancer. That’s usually true even if the biopsy appeared to have removed the whole abnormal area. During surgery, the doctor might also check nearby lymph nodes to see if the melanoma has spread inside the body. Lymph nodes are bean-shaped organs under the skin that store infection-fighting cells.
- Radiation therapy – Radiation can kill cancer cells.
There are three main categories of drug treatments (systemic treatments):
- Immunotherapy – Drugs that stimulate or unleash the immune system to attack and kill the cancer cells. Several different types of immunotherapy have been developed, the most important of which are checkpoint inhibitors nivolumab [brand name: Opdivo], pembrolizumab [brand name: Keytruda], ipilimumab [brand name: Yervoy]), which have largely replaced high-dose interleukin-2 (IL-2). Significant progress has been made in the treatment of patients with metastatic melanoma over the past decade. The anti-programmed cell death 1 (PD-1) checkpoint inhibitors (nivolumab, pembrolizumab) and the combination of nivolumab plus ipilimumab are effective for controlling metastatic melanoma and prolonging life in nearly half of all patients. However, immunotherapy (nivolumab, pembrolizumab, ipilimumab) can be associated with severe side effects. Fortunately, these can usually be controlled with a brief course of immunosuppressive drugs without interfering with the control of the tumor in most cases.
- Targeted therapy – Drugs that inhibit specific enzymes or molecules important to the cancer cells.
- Chemotherapy – Drugs that stop or slow the growth of cancer cells by interfering with their ability to divide or reproduce themselves.