Melanoma Prevention and Treatment Early Detection Saves Lives

Melanoma is a type of skin cancer that develops from melanocytes, the cells responsible for producing melanin, the pigment that gives skin its colour. Although melanoma is less common than some other types of skin cancer, it can behave aggressively and spread to other parts of the body if it is not detected and treated early.

The good news is that many melanomas can be treated successfully when diagnosed at an early stage. Understanding the warning signs, protecting the skin from ultraviolet (UV) radiation and seeking medical evaluation for suspicious skin changes can play an important role in improving outcomes.

Understanding Melanoma and Its Risk Factors

Melanoma can develop on any area of the skin, including areas that receive little sun exposure. It may appear as a new mole or as a change in an existing mole.

Important risk factors include:

• Excessive exposure to UV radiation from sunlight or tanning beds
• Repeated sunburn, particularly during childhood and adolescence
• Having fair skin, light eyes or a tendency to burn easily
• Having many moles or atypical-looking moles
• A personal or family history of melanoma
• Certain inherited genetic conditions that increase melanoma risk
• A weakened immune system

Having one or more risk factors does not mean that a person will definitely develop melanoma. However, people at higher risk may benefit from more frequent skin examinations.

Recognising the Warning Signs of Melanoma

Knowing what changes to look for can help with early detection. The ABCDE rule is commonly used to identify suspicious moles:

A – Asymmetry

One half of the mole does not match the other half.

B – Border

The edges may be irregular, uneven, blurred or poorly defined.

C – Colour

The lesion may contain multiple colours, including shades of brown, black, red, white or blue.

D – Diameter

A melanoma may be larger than 6 mm, although melanoma can also be smaller when first detected.

E – Evolving

Any mole or skin lesion that changes in size, shape, colour or appearance should be evaluated.

Other warning signs can include persistent itching, bleeding, crusting, tenderness or the development of a new unusual-looking lesion.

How Is Melanoma Diagnosed?

A dermatologist usually begins with a detailed examination of the skin and a review of the patient's medical and family history.

Dermoscopy

Dermoscopy uses a specialised magnifying device to examine structures and pigment patterns that may not be visible to the naked eye. It can help a dermatologist determine whether a lesion requires further investigation.

Skin Biopsy

If melanoma is suspected, a skin biopsy is generally required for definitive diagnosis. The suspicious lesion or an appropriate portion of it is removed and examined by a pathologist.

The pathology report helps determine whether melanoma is present and provides important information such as tumour thickness and other features that contribute to staging and treatment planning.

Understanding Melanoma Staging

Treatment depends heavily on the stage of melanoma. Staging considers factors such as tumour thickness, ulceration and whether cancer cells have spread to lymph nodes or distant organs.

Early-stage melanoma is generally confined to the skin and may be treated primarily with surgery. More advanced melanoma may require additional treatments because cancer cells may have spread to lymph nodes or other parts of the body.

In selected patients, a sentinel lymph node biopsy may be recommended to determine whether melanoma has reached nearby lymph nodes.

Additional imaging, such as CT, PET-CT or MRI, may be recommended depending on the stage, symptoms and clinical circumstances.

Surgical Treatment for Melanoma

For many early-stage melanomas, surgery is the main treatment. The melanoma is removed along with an appropriate margin of surrounding healthy-looking skin.

The required margin depends on the thickness and characteristics of the melanoma.

If melanoma has spread to nearby lymph nodes or other sites, additional surgery may sometimes be considered as part of an overall treatment strategy. However, surgery alone is not appropriate for every advanced case.

Immunotherapy for Advanced Melanoma

One of the major advances in melanoma treatment has been the development of immune checkpoint inhibitors.

Medicines such as pembrolizumab and nivolumab help the immune system recognise and attack cancer cells by targeting immune checkpoint pathways. Ipilimumab, which targets CTLA-4, may also be used in selected treatment combinations or situations.

Immunotherapy may be used for advanced melanoma and, in appropriate patients, may also be considered after surgery to reduce the risk of recurrence.

Because these medicines stimulate the immune system, they can cause immune-related side effects affecting organs such as the skin, bowel, liver, lungs or endocrine glands. Patients therefore require appropriate monitoring during treatment.

Targeted Therapy for BRAF-Mutated Melanoma

Some melanomas contain changes in the BRAF gene, particularly the BRAF V600 mutation. Molecular testing can identify whether a tumour carries a mutation that may respond to targeted treatment.

For patients with appropriate BRAF mutations, combinations of BRAF inhibitors and MEK inhibitors can block signalling pathways that drive melanoma growth.

Targeted therapy is different from immunotherapy and is only suitable when the tumour has the relevant molecular alteration.

Treatment of Melanoma That Has Spread

Advanced melanoma can sometimes spread to the lungs, liver, brain, bones or other organs. Treatment is selected according to factors such as the location and extent of spread, molecular characteristics, previous treatments, overall health and patient preferences.

Depending on the situation, treatment may include:

• Immunotherapy
• Targeted therapy for BRAF-mutated melanoma
• Surgery for selected metastatic sites
• Stereotactic radiation for certain brain or other limited metastases
• Other specialised systemic or local treatments in selected cases

Chemotherapy is now used much less frequently than immunotherapy and targeted therapy for advanced melanoma because newer treatments have demonstrated greater effectiveness for many patients.

Can Melanoma Be Prevented?

Not every case of melanoma can be prevented, particularly when genetic or other non-UV-related risk factors are involved. However, reducing unnecessary UV exposure is an important prevention strategy.

Practical measures include:

• Use a broad-spectrum sunscreen with an appropriate SPF and reapply it as directed.
• Wear protective clothing, sunglasses and a wide-brimmed hat when outdoors.
• Seek shade, particularly when UV levels are high.
• Avoid indoor tanning beds.
• Take extra precautions during prolonged outdoor activities.
• Check your skin regularly for new or changing lesions.

Sun protection should be part of everyday skin care rather than something reserved only for holidays or particularly sunny days.

Regular Skin Checks and Early Detection

There is no single screening schedule that is appropriate for everyone. People with a higher risk of melanoma may require regular professional skin examinations, while others may benefit from routine self-examination and prompt assessment of suspicious changes.

People with numerous or atypical moles may sometimes benefit from photographic monitoring or digital dermoscopy under dermatological supervision.

If a mole looks different from your other moles, changes over time or develops symptoms such as bleeding or persistent itching, it should be assessed rather than ignored.

Melanoma During Pregnancy

A melanoma diagnosis during pregnancy requires individualised care involving dermatology, oncology and obstetric teams where appropriate.

A suspicious skin lesion can generally be evaluated during pregnancy, and necessary procedures should not automatically be delayed because of pregnancy. If melanoma treatment is required, the timing and choice of treatment depend on the stage of disease and pregnancy-related considerations.

People who have previously been treated for melanoma and are planning a pregnancy should discuss their individual circumstances with their oncology team.

Living After Melanoma Treatment

Follow-up after melanoma treatment is important because there is a risk of recurrence, and people who have had melanoma may also have an increased risk of developing another melanoma.

Follow-up may include:

• Regular skin examinations
• Monitoring of lymph nodes and other areas based on clinical findings
• Education about self-examination
• Imaging when clinically indicated
• Monitoring for treatment-related side effects
• Ongoing sun-protection measures

Routine blood tests or scans are not required for every melanoma survivor. The follow-up plan should be based on the individual's stage, treatment history and risk of recurrence.

Emotional Support During Melanoma Treatment

A cancer diagnosis can cause anxiety, uncertainty and emotional stress. Concerns about recurrence, treatment side effects, body image and future health are common.

Psychological counselling, support groups, family support and communication with the healthcare team can help patients manage these challenges. Palliative care may also be introduced at any stage of serious cancer to help control symptoms and improve quality of life; it does not mean that active cancer treatment has necessarily stopped.

When Should You See a Dermatologist?

You should consider medical evaluation if you notice:

• A new or unusual mole
• A mole that is changing in size, shape or colour
• An irregular or multi-coloured lesion
• A mole that repeatedly bleeds or crusts
• Persistent itching or tenderness in a skin lesion
• A spot that looks noticeably different from the others on your skin

Early assessment does not necessarily mean that a lesion is cancerous. Many unusual-looking moles are benign, but professional examination can help determine whether further testing is needed.

Final Thoughts

Melanoma prevention and early detection remain important parts of skin cancer care. Limiting UV exposure, practising regular skin awareness and seeking medical evaluation for suspicious changes can help identify melanoma at an earlier stage.

For people diagnosed with melanoma, treatment is based on the stage, tumour characteristics and overall health. Advances in surgery, immunotherapy, targeted therapy and radiation have expanded treatment options, particularly for patients with more advanced disease.

If you notice a new or changing skin lesion, speak with a dermatologist rather than waiting for it to resolve on its own. Early evaluation can make an important difference in determining the appropriate next step.