Melanoma is the fourth most common cancer diagnosed in Australia and is the most dangerous type of skin cancer.
Melanoma is a familiar word to most Australians.
But it’s only when melanoma directly impacts our lives that we begin to understand the seriousness of this type of skin cancer.
Unfortunately, Australia has the highest incidence of melanoma in the world. On average, 30 Australians will be diagnosed with melanoma every day and more than 1,200 will die from the disease each year.
That’s why the team at Melanoma Institute Australia is committed to finding new ways to prevent, treat and promote awareness of this deadly disease.
The following information will help you gain a better understanding of melanoma, including what it is, how it’s diagnosed, the different stages of the disease, treatment options, real patient stories, and support available to those diagnosed with melanoma.
The irony of melanoma is that it is both the most deadly cancer and the easiest to treat when caught early. Melanoma arises most commonly from a mole-gone-wrong, and when spotted early, stage 1 melanoma can be treated completely simply by removing it. But if it goes undetected or unreported and spreads to other areas of the body it becomes very dangerous.
Why a common mole can turn into melanoma is not entirely understood. But there is a clear and resounding link to overexposure to sunlight. And a pattern of sunburns coupled with other relative risk factors such as complexion and family history can add up to greater risk for some people. But it’s unequivocal that the best protection is prevention by practicing sun safety and early detection with regular skin checks.
Historically, treatment options for melanoma that had progressed past stage 2 were very limited. These days, though, the story is changing thanks in part to the work of Melanoma Institute Australia. With exciting discoveries in the area of targeted drug therapies and refined staging techniques melanoma patients now have new options and more hopeful outcomes
What is melanoma?
Melanoma is a form of cancer that develops in the skin’s pigment cells.
How is it diagnosed?
Most melanoma diagnosis starts with a physical examination of a suspicious looking spot or mole.
Stages of melanoma
Stages of progression are based on tumor size, ulceration and involvement of other organs.
Treatment depends on a number of factors, including the stage of melanoma, age and health.
Incidence and mortality
In 2010, 11,405 new cases of melanoma were diagnosed in Australia, accounting for nearly one in ten cancer diagnoses.
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.
In Australia in 2011, there were 1544 deaths due to melanoma.
Melanoma is the sixth most common cause of cancer death in Australian men and tenth most common in Australian women.
Individuals at high risk of melanoma (see risk factors below) should be taught to check their skin for irregular or changing lesions, and have annual checks by a dermatologist.
Symptoms and diagnosis
Often melanoma has no symptoms, however it can be associated with changes that relate to ‘ABCDE’ – Asymmetry, irregular Border, uneven Colour, Diameter (usually over 6mm), Evolving (changing and growing). Other symptoms include dark areas under nails or on membranes lining the mouth, vagina or anus.
Diagnosis is by biopsy to remove the whole lesion.
If the excised lesion is thick, a biopsy of the first draining lymph node (sentinel node) is performed. 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.
Melanoma risk increases with exposure to UV radiation, particularly with episodes of sunburn (especially during childhood).
Melanoma risk is increased for people who have:
•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.
Avoid sunburn by minimising sun exposure when the SunSmart UV Alert 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).
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.
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.
For widespread disease, chemotherapy is borderline effective and drugs such as dacarbazine can palliate symptoms, as can biologicals like interferon or interleukin 2. Radiotherapy may palliate local symptoms.
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. Five year survival for people diagnosed with melanoma is 91%, rising to 99% if the melanoma is detected before it has spread. If spread is within the region of the primary melanoma, the five year survival is 65%, dropping to 15% if the disease is widespread.