Malignant melanoma is the most deadly form of skin cancer. While less common than other types of skin cancer, the incidence of malignant melanoma is steadily increasing. It is the leading cause of death from skin disease.

In the year 2000, almost 50,000 cases of malignant melanoma were expected, and in the United States 1 in 85 people developed melanoma at some point in their life. The risk of melanoma increases with age, but nonetheless the disease frequently affects young, otherwise healthy people. Melanoma is the number one cause of cancer death in women aged 25 to 30.

Malignant melanoma involves cancerous changes to the skin cells that produce the skin's pigment, which is known as melanin. Melanoma may appear on normal skin or arise from a nevus (moles) or other abnormal skin area that has changed in appearance.

Some congenital nevi (dark areas present at birth) may develop into melanomas. Spitz Nevi are benign brown areas of skin in children that do not develop into melanoma, but can sometimes be difficult to distinguish from melanoma.

There are 4 major types of melanoma:

• Superficial spreading melanoma is the most common type of melanoma (70% of cases). It is usually flat and irregular in shape and color with varying shades of black and brown. It may occur at any age or site and is most common in Caucasians.
• Nodular melanoma (15% of cases) usually starts as a raised area that is dark black-blue or bluish-red, however some can lack color.
• Lentigo maligna melanoma (5% of cases) usually occurs in the elderly. It is most common in sun damaged skin on the face, neck, and arms. The abnormal skin areas are usually large, flat, and tan with intermixed areas of brown.
• Acral lentiginous melanoma is the least common form of melanoma. It usually occurs on the palms, soles, or under the nails. It is more common in African Americans.

Melanoma is related to sun exposure, particularly to sunburns during childhood, and is most common in those with fair skin, blue eyes, and red or blonde hair.

• skin lesion or growth
  • usually a papule (raised) or, less likely, a macule (flat)
  • color varying (brown, black, red, or bluish)
  • mixture of colors in one lesion
  • irregular borders, often asymmetrical
  • a change in appearance over time in pigmented skin lesion
  • bleeding from a skin growth
• ABCDs help people remember the features of abnormal skin that are suspicious for melanoma:

• Asymmetry: one half of the abnormal skin area is different than the other half
• Borders: irregular borders
• Color: varied from one area to another with shades of tan, brown, or black (sometimes white, red, blue)
• Diameter: usually (but not always) larger than 6mm in size (diameter of a pencil eraser)

The goal of treatment is to cure the cancer.

Surgical removal of the tumor, with a margin of normal skin, is usually required. Surgical removal of nearby lymph nodes or a procedure called a "sentinel lymph node biopsy" may accompany removal of the tumor.

Patients with tumors deeper than 4mm or with lymph nodes involved have a high risk of developing melanoma elsewhere in the body. For patients at high risk of melanoma spread (metastasis), interferon may be recommended following surgery, because giving interferon for one year improves the overall chance of cure by approximately 10%.

However, interferon has many side effects and is sometimes difficult to tolerate. Patients with high risk melanomas should consider enrolling in clinical trials (research studies of new medications or other treatments).

For patients with melanoma that has spread beyond the skin and lymph nodes to other organs (metastatic melanoma), treatment is more difficult. Metastatic melanoma is usually not curable.

Treatment is usually directed at shrinking the tumor and improving symptoms. Both chemotherapy and use of immunologic agents (such as interferon and interleukin) may be tried. These patients also should consider participating in clinical trials.

• spread to deep tissues with damage to structure or function
• metastasis of tumor to other locations within the body

Minimize sun exposure. Protect skin from the sun -- wear protective clothing (such as hats, long sleeved shirts, long skirts, or pants). Sunlight is most intense at mid-day, so try to avoid exposure during these hours.

Use high quality sunscreens, preferably with SPF (sun protection factor) ratings of at least 15. Apply sunscreen at least one-half hour before exposure, and reapply frequently. Use sunscreen for winter exposure also.

Examine the skin regularly for development of suspicious growths or changes in an existing skin lesion. A new growth that ulcerates or is slow to heal is suspicious. Suspicious changes in existing growths include change in color, size, texture, appearance, or development of pain, inflammation, bleeding, or itching.

A lesion that is asymmetrical, has irregular or diffuse borders, has multiple colors mixed in one lesion, or is larger than 6 millimeters in diameter is suspicious.