Malignant melanoma, a form of malignant black skin cancer, is a tumor that primarily occurs on the outer layer of the skin. Malignant melanomas develop from abnormal pigment-producing skin cells and, if left untreated, can spread rapidly to other parts of the body. The incidence of skin cancer is steadily increasing. Today, about one in 75 people will develop melanoma at some point in their lives.
Below you will find further information as well as a list of selected melanoma specialists.
The Causes of Malignant Melanoma
Heavy UV exposure and repeated sunburns during childhood and adolescence dramatically increase the risk of melanoma. People with
- fair skin and light-colored eyes, as well as
- red or blond hair.
Other risk factors include:
- a history of cancer,
- numerous or unusual moles,
- melanocytic skin tumors present before birth,
- freckles, and
- xeroderma pigmentosum.
Symptoms of skin cancer
So-called amelanotic melanomas, which lack pigmentation, are rare. These occur primarily on the hands or feet.
At the time of diagnosis, the majority of skin cancer patients have no symptoms. In some cases, however, a melanoma presents with visible changes in the skin. These include an increase in the size of a mole, changes in color, or irregular borders. Such changes should always be evaluated by a dermatologist. Most tumors are diagnosed during screening examinations. Only occasionally do patients notice mild itching or minor bleeding beforehand.
Malignant melanoma can generally be classified into different types. The following factors are used to distinguish between them:
- the specific type of tumor,
- the thickness of the tumor, and
- the exact location.
The following forms of melanoma are distinguished:
- Superficial spreading melanoma (SSM) tends to develop in a flat manner.
- Nodular melanoma (NM) grows in nodules and often bleeds.
- Lentigo maligna melanoma (LMM) tends to grow slowly and occurs primarily on the face in older people.
- Acro-lentiginous melanoma (ALM) primarily develops under the nails and on the soles of the feet and palms of the hands.
Melanomas of the mucous membranes, choroidal melanomas in the eye, and melanomas of the meninges are also possible but rather rare.
ABCDE Rule
It is not always possible to tell at first glance whether a spot is simply a normal mole or a melanoma. However, a preliminary distinction can be made using the so-called ABCDE rule:
- A for Asymmetry: A melanoma is irregularly shaped.
- B for Border: The border is rather blurred and irregular.
- C for Color: It exhibits a mixture of brown, blue, red, white, and black.
- D for Diameter: The mole has a diameter of more than 5 millimeters.
- E for Elevation: A melanoma usually protrudes above the normal skin surface.
Diagnosing Melanoma
It is also recommended to have a skin cancer screening performed by your primary care physician or dermatologist every two years. The doctor will then examine any suspicious moles with a dermatoscope. This allows them to assess the exact pigment structure of the moles.
If the suspicion of cancer is confirmed, the affected area is surgically removed under local anesthesia and examined under a microscope.
If the diagnosis of “melanoma” is then confirmed, the tumor thickness must be determined according to the Breslow scale. This is the most important prognostic factor for skin cancer. In early stages, a condition known as melanoma in situ may also be present. In this case, the tumor is still confined exclusively to the outermost layer of the skin and has not yet infiltrated the underlying tissue.
If the tumor is thicker than one millimeter, diagnostic testing to assess the extent of the disease must be performed. The goal is to detect metastases in other organs and lymph nodes at an early stage. This may include, for example,
- ultrasound,
- X-rays,
- computed tomography (CT), and/or
- magnetic resonance imaging (MRI)
are used.
Melanoma – Possible Targeted Therapies
The most important form of treatment is the surgical removal of the malignant melanoma. The tumor is always removed in its entirety to prevent metastasis. During removal, care should also be taken to ensure a sufficiently large safety margin of one to two centimeters.
When treating malignant melanoma, doctors follow international medical recommendations. Modern treatment approaches are often determined based on current dermatological guidelines.
If the tumor is 1 to 0.75 millimeters thick, the surgeon also removes the so-called sentinel lymph nodes. These are the lymph nodes that first come into contact with the lymph fluid from the tumor area. If the sentinel lymph node is also affected by cancer, the surrounding lymph nodes are also removed.
If the tumor is thicker or the lymph nodes are involved, the patient is recommended to undergo adjuvant therapy. The patient receives interferon alpha over a period of 18 months. This is a chemical substance intended to prevent a possible tumor recurrence (return of the cancer).
If the tumor has already metastasized, a complete cure is rather unlikely. Treatment then aims to prolong life. In addition to chemotherapy with cytostatic drugs (cell growth inhibitors),
- additional surgical procedures to reduce the tumor mass or
- radiation therapy.
Modern drug therapies are also frequently used in patients with metastatic melanoma. These include various forms of systemic therapy, such as immune checkpoint inhibitors or targeted drugs.
Another treatment approach for malignant melanoma is stimulating the immune system with antibodies. If successful, the immune system can fight the cancerous cells on its own. Various immunotherapy methods are also currently undergoing clinical trials.
After treatment is completed, follow-up care also plays an important role. During regular checkups, doctors monitor patients for new skin changes or the recurrence of tumor cells. This allows potential relapses to be detected and treated early.
Chances of Recovery & Life Expectancy for Patients with Malignant Melanoma
A particularly crucial factor for the prognosis is how far the disease has already progressed at the start of treatment. The Breslow thickness of the tumor and the depth of invasion, as determined by the so-called Clark level, play an important role here. If the melanoma is still small and growing mainly on the surface, the prognosis is quite good.
If the tumor is already in advanced stages, the risk of metastases in distant organs increases significantly. In such cases, long-term oncological care is particularly important.
The chances of a cure worsen if the tumor has already spread beyond the dermis (the middle layer of the skin). If metastases are present in
, a cure is virtually impossible.
The 10-year survival rate for malignant melanoma is around 80 percent. This means that 80 percent of all patients are still alive 10 years after diagnosis.
In cases of lymph node metastases and metastases in other organs, however, the 10-year survival rate drops to just 10 to 20 percent.
Prevention of Skin Cancer
Preventing skin cancer plays an important role. This includes consistent sun protection, avoiding intense UV radiation, and regular skin checkups with a dermatologist. Early detection of skin changes can significantly improve treatment outcomes.
FAQ
What exactly is malignant melanoma?
Malignant melanoma is an aggressive form of skin cancer that originates in pigment-producing cells. These tumor cells can spread throughout the body and form metastases.
How does malignant melanoma develop?
Malignant melanoma usually develops as a result of long-term damage to the skin caused by UV rays, such as from intense sun exposure or frequent sunburns.
What types of melanoma are there?
The most common types include superficial spreading melanoma, nodular melanoma, and rarer variants such as acrolentiginous melanoma.
When should patients see a doctor?
If a mole visibly changes or a new, unusual skin mark appears, a patient should see a dermatologist as soon as possible to rule out the possibility of melanoma.
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Sabine Schneider
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Sabine Schneider – medical author: Explore expert articles and medical expertise in the Leading Medicine Guide.
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