The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:
There are two main forms of skin cancer: melanoma and nonmelanoma.
Melanoma is a rare form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips). This summary is about cutaneous (skin) melanoma and melanoma that affects the mucous membranes.
Before age 50, rates of melanoma are higher in women than in men. After age 50, rates of melanoma are much higher in men. Melanoma is most common in adults, but it is sometimes found in children and adolescents. Learn more about Childhood Melanoma Treatment.
The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body. Learn more about Skin Cancer Treatment.
In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma forms most often on the arms and legs.
When melanoma occurs in the eye, it is called intraocular or ocular melanoma. Learn more about Intraocular (Uveal) Melanoma Treatment.
A risk factor is anything that increases the chance of getting a disease. Some risk factors for melanoma, such as tanning bed use, can be changed. However, risk factors also include things people cannot change, like their genetics and their family history. Learning about risk factors for melanoma can help you make changes that might lower your risk of getting it.
Risk factors for melanoma include:
Being White or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.
Learn more about risk factors for melanoma at Genetics of Skin Cancer and Skin Cancer Prevention.
These and other signs and symptoms may be caused by melanoma or by other conditions. Check with your doctor if you have:
The acronym ABCDE can help you remember the signs of melanoma:
Find pictures and descriptions of common moles and melanoma at Common Moles, Dysplastic Nevi, and Risk of Melanoma.
Melanoma is usually diagnosed with tests that examine the skin. The process used to find out if cancer cells have spread beyond the skin is called staging. To plan treatment, it is important to know the stage of the disease.
In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures to find and diagnose melanoma:
There are four main types of skin biopsies. The type of biopsy done depends on where the abnormal area formed and the size of the area.
The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
For melanoma that is not likely to spread to other parts of the body or recur, more tests may not be needed. For melanoma that is likely to spread to other parts of the body or recur, the following tests and procedures may be done after surgery to remove the melanoma:
The results of these tests are viewed together with the results of the tumor biopsy to find out the stage of the melanoma.
You may want to get a second opinion to confirm your melanoma diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.
To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. You can contact NCI's Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, see Questions to Ask Your Doctor about Cancer.
The prognosis and treatment options depend on:
Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It is important to know the melanoma stage to plan treatment.
There are several staging systems for cancer that describe the extent of the cancer. Melanoma staging usually uses the TNM staging system. The cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to your cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages.
Learn about tests to stage melanoma. Learn more about Cancer Staging.
To find out the stage of melanoma, the tumor is completely removed and nearby lymph nodes are checked for signs of cancer. The stage of the cancer is used to determine which treatment is best. Check with your doctor to find out which stage of cancer you have.
The stage of melanoma depends on:
In stage 0, abnormal melanocytes are found in the epidermis. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
Stage II is divided into stages IIA, IIB, and IIC.
Stage III is divided into stages IIIA, IIIB, IIIC, and IIID.
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In stage IV, the cancer has spread to other parts of the body, such as the lung, liver, brain, spinal cord, bone, soft tissue (including muscle), digestive tract, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first started.
Stage IV melanoma is also called metastatic melanoma. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if melanoma spreads to the lung, the cancer cells in the lung are actually melanoma cells. The disease is called metastatic melanoma, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.
Recurrent melanoma is melanoma that has come back after it has been treated. If melanoma comes back, it may come back in the area where it first started or in other parts of the body, such as the lungs or liver. Tests will help determine where in the body the cancer has returned. The type of treatment that you have for recurrent melanoma will depend on where it has come back.
Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in the booklet When Cancer Returns.
Different types of treatment are available for people with melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for people with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. People may want to think about taking part in a clinical trial. Some clinical trials are open only to people who have not started treatment.
Surgery to remove the tumor is the primary treatment for all stages of melanoma. A wide local excision is used to remove the melanoma and some of the normal tissue around it. Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.
Sometimes, it is important to know whether cancer has spread to the lymph nodes. Lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the sentinel lymph node, which is the first lymph node the cancer is likely to spread to from the primary tumor.
If only a small amount of cancer cells are found during a sentinel lymph node biopsy, active surveillance with ultrasound may be recommended instead of more surgery.
After the doctor removes all the melanoma that can be seen at the time of the surgery, some people may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after the surgery to lower the risk that the cancer will come back is called adjuvant therapy.
Surgery to remove cancer that has spread to the lymph nodes, lung, digestive tract, bone, or brain may be done to improve quality of life by controlling symptoms.
Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
One type of regional chemotherapy is hyperthermic isolated limb perfusion. With this method, anticancer drugs go directly to the arm or leg the cancer is in. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drug is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Learn more about how chemotherapy works, how it is given, common side effects, and more at Chemotherapy to Treat Cancer and Chemotherapy and You: Support for People With Cancer.
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy is used to treat melanoma and may also be used as palliative therapy to relieve symptoms and improve quality of life.
Learn more about External Beam Radiation Therapy for Cancer and Radiation Therapy Side Effects.
Immunotherapy helps a person's immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about Biomarker Testing for Cancer Treatment.
Immunotherapy drugs used to treat melanoma include:
Learn more about Immunotherapy to Treat Cancer.
Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Your doctor may suggest biomarker tests to help predict your response to certain targeted therapy drugs. Learn more about Biomarker Testing for Cancer Treatment.
Targeted therapies used to treat melanoma include:
Learn more about Targeted Therapy to Treat Cancer.
Vaccine therapy is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it. Vaccine therapy is being studied in the treatment of stage III melanoma that can be removed by surgery.
For information about side effects caused by treatment for cancer, visit our Side Effects page.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
Treatment of stage 0 is usually surgery to remove the area of abnormal cells and a small amount of normal tissue around it.
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of stage I melanoma is usually surgery to remove the tumor and some of the normal tissue around it, with or without lymph node mapping and removal of lymph nodes.
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of stage II melanoma may include:
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of stage III melanoma that can be removed by surgery may include:
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma may include:
Learn more about these treatments in the Treatment Option Overview.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For more information from the National Cancer Institute about melanoma:
For general cancer information and other resources from the National Cancer Institute, visit:
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PDQ® Adult Treatment Editorial Board. PDQ Melanoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389388]
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