Skin cancer is the most common type of cancer and usually forms in skin that has been exposed to sunlight, but can occur anywhere on the body.
More resources for Melanoma from Patient Empowerment Network.
When it comes to cancer treatment you or a loved one may be considering participating in a clinical trial as a treatment option. Clinical trials are designed to evaluate the safety and effectiveness of a treatment. They may involve researchers administering drugs, taking blood or tissue samples, or checking the progress of patients as they take a treatment according to a study’s protocol.
Learning about clinical trials can be a steep learning curve – not least because the process comes with a lot of new terms, acronyms and jargon. To help you, I’ve put together this list of the most common terms you will find when you are researching clinical trial information. This is not an exhaustive list but it is a helpful starting point. At the end of this article you will see links to find more information.
Adverse Effects (AE)
Also called Adverse Events, or Adverse Drug Reaction, AEs are any harmful event experienced by a person while they are having a drug or any other treatment or intervention. In clinical trials, researchers must always report adverse events, regardless of whether or not the event is suspected to be related to or caused by the drug, treatment or intervention.
Subsection of people within a study who have a particular intervention.
Bias is an error that distorts the objectivity of a study. It can arise if a researcher doesn’t adhere to rigorous standards in designing the study, selecting the subjects, administering the treatments, analysing the data, or reporting and interpreting the study results. It can also result from circumstances beyond a researcher’s control, as when there is an uneven distribution of some characteristic between groups as a result of randomization.
Blinding is a method of controlling for bias in a study by ensuring that those involved are unable to tell if they are in an intervention or control group so they cannot influence the results. In a single-blind study, patients do not know whether they are receiving the active drug or a placebo. In a double-blind study, neither the patients nor the persons administering the treatments know which patients are receiving the active drug. In a triple-blind study, the patients, clinicians/researchers and the persons evaluating the results do not know which treatment patients had. Whenever blinding is used, there will always be a method in which the treatment can be unblinded in the event that information is required for safety.
When a treatment for a specific medical condition already exists, it would be unethical to do a randomized controlled trial that would require some participants to be given an ineffective substitute. In this case, new treatments are tested against the best existing treatment, (i.e. a comparator). The comparator can also be no intervention (for example, best supportive care).
A trial is considered completed when trial participants are no longer being examined or treated (i.e. no longer in follow-up); the database has been ‘locked’ and records have been archived.
A group of people in a study who do not have the intervention or test being studied. Instead, they may have the standard intervention (sometimes called ‘usual care’) or a dummy intervention (placebo). The results for the control group are compared with those for a group having the intervention being tested. The aim is to check for any differences. The people in the control group should be as similar as possible to those in the intervention group, to make it as easy as possible to detect any effects due to the intervention.
How beneficial a treatment is under ideal conditions (for example, in a laboratory), compared with doing nothing or opting for another type of care. A drug passes efficacy trials if it is effective at the dose tested and against the illness for which it is prescribed.
Eligibility Criteria/ Inclusion and Exclusion Criteria
Eligibility criteria ensures patients enrolling in a clinical trial share similar characteristics (e.g. gender, age, medications, disease type and status) so that the results of the study are more likely due to the treatment received rather than other factors.
Observation over a period of time of participants enrolled in a trial to observe changes in health status.
A process (by means of a written informed consent form) by which a participant voluntarily agrees to take part in a trial, having been informed of the possible benefits, risks and side effects associated with participating in the study.
The treatment (e.g., a drug, surgical procedure, or diagnostic test) being researched. The intervention group consists of the study participants that have been randomly assigned to receive the treatment.
A person responsible for the conduct of the clinical trial at a trial site. If a trial is conducted by a team of individuals at a trial site, the investigator is the responsible leader of the team and may be called the principal investigator (PI).
A clinical trial conducted according to a single protocol but at more than one site, and therefore, carried out by more than one investigator.
Number needed to treat (NNT)
The average number of patients who need to receive the treatment or other intervention for one of them to get the positive outcome in the time specified.
The impact that a test, treatment, or other intervention has on a person, group or population.
Phase I, II, III and IV Studies
Once the safety of a new drug has been demonstrated in tests on animals, it goes through a multi-phase testing process to determine its safety and efficacy in treating human patients. If a drug shows success in one phase, the evaluation moves to the next phase
- Phase 1 tests a drug on a very small number of healthy volunteers to establish overall safety, identify side effects, and determine the dose levels that are safe and tolerable for humans.
- Phase II trials test a drug on a small number of people who have the condition the drug is designed to treat. These trials are done to establish what dose range is most effective, and to observe any safety concerns that might arise.
- Phase III trials test a drug on a large number of people who have the condition the drug is designed to treat. Successful completion of Phase III is the point where the drug is considered ready to be marketed.
- Phase IV trials can investigate uses of the drug for other conditions, on a broader patient base or for longer term use.
A fake (or dummy) treatment given to patients in the control group of a clinical trial. Placebos are indistinguishable from the actual treatment and used so that the subjects in the control group are unable to tell who is receiving the active drug or treatment. Using placebos prevents bias in judging the effects of the medical intervention being tested.
A group of people with a common link, such as the same medical condition or living in the same area or sharing the same characteristics. The population for a clinical trial is all the people the test or treatment is designed to help.
A plan or set of steps that defines how something will be done. Before carrying out a research study, for example, the research protocol sets out what question is to be answered and how information will be collected and analysed.
Randomized Controlled Trial (RCT)
A study in which a number of similar people are randomly assigned to 2 (or more) groups to test a specific drug, treatment or other intervention. One group has the intervention being tested; the other (the comparison or control group) has an alternative intervention, a placebo, or no intervention at all. Participants are assigned to different groups without taking any similarities or differences between them into account. For example, it could involve using a computer-generated random sequence. RCTs are considered the most unbiased way of assessing the outcome of an intervention because each individual has the same chance of having the intervention.
The ability to get the same or similar result each time a study is repeated with a different population or group.
People in a study recruited from part of the study’s target population. If they are recruited in an unbiased way, the results from the sample can be generalised to the target population as a whole.
In clinical trials, the people selected to take part are called subjects. The term applies to both those participants receiving the treatment being investigated and to those receiving a placebo or alternate treatment.
The location where trial-related activities are conducted.
A Stanford Medicine X e-Patient scholar, Marie Ennis O’Connor is an internationally recognized keynote speaker, writer, and consultant on global trends in patient engagement, digital health and participatory medicine. A board member of the Patient Empowerment Foundation, a network of people, foundations, organizations and medical institutions dedicated to empowering patients worldwide, Marie’s work is informed by her passion for embedding the patient voice at the heart of healthcare values. She writes about the experience of transitioning from breast cancer patient to advocate on her award-winning blog Journeying Beyond Breast Cancer.
Suja JohnkuttyHi there ! I’m Suja Johnkutty, MD a conscientious mom and neurologist . My one simple goal is to provide you honest, practical, simple action steps to experience better relaxation in your life. https://betterrelaxation.com
Hi there ! I’m Suja Johnkutty, MD a conscientious mom and neurologist . My one simple goal is to provide you honest, practical, simple action steps to experience better relaxation in your life.
This podcast was originally published by Cornell Weill Cancer Cast, on March 22, 2019, here.
This podcast was originally published by I had Cancer on July 16, 2019, here.
Jessica Rogowicz got her first melanoma diagnosis three days before her 25th birthday and another at age 29. Jessica, now 36, talks about her treatment and how she started a foundation for melanoma research and awareness. The I Had Cancer podcast provides personal and truthful conversations with cancer survivors along their journeys. Each episode will feature a different person with their unique perspective on their own fight against cancer. They are sharing their stories to help others who might be facing similar challenges and to say they went from “I Have Cancer” to “I Had Cancer.” If you would like to be a guest on a future I Had Cancer Podcast, send an email to IHadCancer@highmarkhealth.org with your name and phone number. The views and opinions expressed in this program are those of the participants and do not reflect the views or opinions of AHN, its subsidiaries or affiliates. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
This resource was originally published by Melanoma International here.
Search by type of resource
Caregiver Resources, Clinical Trials, Prescription Drug Assistance, Support, Hospice, Hotlines and Forums, Insurance/Financial Assistance, Lodging, Lymphedema, Other Types of Melanoma, Pain Management, Radiation, Suggested Reading, Survivorship, Transportation
Caregiver Action Network
1130 Connecticut Ave, NW
Washington, DC 20036
Phone: (202) 454-3970
Caregiver Action Network works to improve the quality of life for the more than 90 million Americans who care for loved ones with chronic conditions, disabilities, disease, or the frailties of old age. CAN (the National Family Caregivers Association) is a non-profit organization providing education, peer support, and resources to family caregivers across the country free of charge.
Family Caregiver Alliance
785 Market Street
San Francisco, CA 94103
FCA seeks to improve the quality of life for caregivers through education, services, research, and advocacy. FCA’s National Center on Caregiving offers information on current social, public policy and caregiving issues, and provides assistance in the development of public and private programs for caregivers.
The Caregiver Relief Fund
900 South Wabash Avenue
Chicago, IL 60605
A social venture committed to caring for caregivers. Provides resources, assistance and a voice to over 50 million Americans who are currently caregivers to the chronically ill, aged and disabled.
9500 Euclid Avenue R36
Cleveland, OH 44195
The 4th Angel Program is part of the Scott Hamilton CARES Initiative. This is a free, national service which provides a one-to-one supportive relationship (phone or email based) to cancer patients and their caregivers. The program has over 400 patient and caregiver mentors who are at least 6 months post treatment, and continues to train more mentors.
Irving, Texas 75015
Organization strives to educate and assure caregivers and oncology teams there are ways to ease the journey’s relentless demands. Goal is to help caregivers emerge on the other end with less stress, more energy and a feeling of accomplishment that they did all they could for their loved ones.
3350 Griffin Road
Fort Lauderdale, FL 33312
A leading provider of information, support and guidance for family and professional caregivers. Founded in 1995as a producer of Today’s Caregiver magazine, the first national magazine dedicated to caregivers. Caregiver Media Group and all of its products are developed for caregivers, about caregivers and by caregivers.
The National Cancer Institute at the National institute of Health
A registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and phone numbers for more details.
The Perelman Center for Advanced Medicine
3400 Civic Center Blvd
Philadelphia, PA 19104
Comprehensive information about specific types of cancer, updates on cancer treatments and news about research advances. Information is updated every day and provided at various levels, from introductory to in-depth.
Dermatology & Early Detection
Center for Disease Control (CDC) Centers for Disease Control and Prevention
4770 Buford Hwy NE
Atlanta, GA 30341
Federal agency that provides information on cancer prevention and control.
American Academy of Dermatology
930 E. Woodfield Road
Schaumburg, IL 60173
1445 New York Avenue, NW, Suite 800
Washington, DC 20005
(866) 503-SKIN (7546)
International: (847) 240-1280
Founded in 1938. With a membership of more than 17,000, it represents virtually all practicing dermatologists in the United States, as well as a growing number of international dermatologists. Find free screening locations as well as information on research, diagnosis and treatment.
The Department of Dermatology and Skin Science
University of British Columbia
835 West 10th Avenue
Canada V5Z 4E8
DermWeb is a premier destination for dermatology links and resources on the Web. There are several areas of interest for practicing dermatologists, for dermatology students, and for the general public.
The Skin Cancer Foundation
149 Madison Av.
New York, NY 10016
Educates about skin cancer and its prevention by means of sun protection; as well as the need for early detection, and prompt, effective treatment. It is the only international organization devoted solely to combating the world’s most common cancer, now occurring at epidemic levels.
National Cancer Institute
6116 Executive Boulevard, Suite 300
Bethesda, MD 20892
The NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.
Prescription Drug Assistance
Needy Meds, Inc.
P.O. Box 219
Gloucester, MA 01931
This service provides information on drugs and offers applications (if available) for financial assistance, coupons for drugs, discount drug cards, free/low cost clinics and government program information.
Together Rx Access Card
One Outlet Lane
Bald Eagle Court
Lock Haven, PA 17745
Free prescription savings program for qualified enrollees, which provides savings on more than 300 FDA-approved prescription drugs.
Partnership for Prescription Assistance
This program helps uninsured and financially struggling patients get access to nearly 500 healthcare and prescription assistance programs that offer medicines for free or nearly free.
National Conference of State Legislatures
State Pharmaceutical Assistance Programs
More than 30 states have programs that will give discounts on prescription drugs, often for free. Visit web site to learn more about the various programs state legislatures have developed.
111 Brewster Street
Pawtucket, RI 02860
Patient assistance programs run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine. RxAssist offers a comprehensive database of these patient assistance programs, as well as practical tools, news, and articles.
P.O. Box 42886
Cincinnati, OH 45242
Advocate in making the patient assistance program journey easier and faster by supplying vital information and help.
The Cancer Support Community
1050 17th Street, NW
Washington DC 20036
An international non-profit dedicated to providing support to people affected by cancer. Services are available through a network of professionally led community-based centers, hospitals, community oncology practices and other non-profits, as well as online.
Fighting Cancer with Hope
9575 Katy Freeway, Suite 428
Houston, Texas 77024
Cancer survivors of more than 50 different types of cancer volunteer for CanCare to provide emotional support to those currently facing a battle with cancer. Family members of survivors provide emotional support to family members of cancer patients.
1715 Yankee Doodle Road
Eagan, MN 55121
Free, personal and private websites that connect people experiencing a significant health challenge to family and friends, making each health journey easier.
MyLifeLine.org Cancer Foundation
A 501(c)(3) nonprofit organization that encourages cancer patients and caregivers to create free, customized websites. Our mission is to empower patients to build an online support community of family and friends to foster connection, inspiration, and healing.
275 Seventh Ave. Floor 22
New York, NY 10001
National Office serves people with cancer and their loved ones throughout the entire 50 states, Puerto Rico, and the U.S. Virgin Islands.
US Dept of Health & Human Services
Write to healthfinder.gov at Health and Human Services Department for easy entry point to trustworthy health information.
National Cancer Institute (NCI)
Very comprehensive information from the US Government agency wing of the National Institute of Health (NIH).
A medical education site from a company that helps both consumers and healthcare providers navigate the healthcare community.
HFA Hospice Foundation of America
1710 Rhode Island Ave, NW
Washington, DC 20036
National Hospice Foundation
1731 King Street, Suite 200
Alexandria, Virginia 22314
Hotlines and Forums
Melanoma International Foundation
Toll free Patient and Family Helpline: 1-866-463-6663
Forum: Melanoma Forum
Dana Farber Cancer Institute
Family Studies Cancer Risk Line
Information regarding familial cancers
Patient Advocate Foundation
1-800-532-5274 (Mon.-Thurs., 8am-8pm; Fri., 8:30am-7pm EST)
Provides education and legal counseling to cancer patients (relative to a diagnosis) concerning managed care, discrimination, insurance and financial issues.
Hereditary Cancer Center
Creighton University School of Medicine
2500 California Plaza
Omaha, NE 68178
1-800-648-8133 (Mon.-Fri., 8am-5pm CST)
Studies family-linked cancer. Counseling, information on clinical trials, cancer and hereditary factors.
Cancer Information Service
Sponsored by National Cancer Institute.
Provides information about cancer and cancer-related resources to patients, the public and health professionals. Offers one-on-one smoking cessation counseling and literature. Free publications.
Skin Cancer Foundation
1-800-754-6490 (Mon.-Fri., 9am-5pm EST)
Provides educational materials and information on skin cancer and treatment.
Cancer Research Institute
1-800-992-2623 (Mon.-Fri., 9am-5pm EST)
Provides general cancer resource information. Supports leading-edge research aimed at developing immunologic methods of preventing, treating and curing cancer.
Cancer Information and Counseling Line
(Mon.-Fri., 8:30am-5pm MST)
Provides current medical information and counseling for cancer issues.
Cancer Hope Network
1-877-467-3638 (Mon.-Fri., 9am-5:30pm EST)
One-on-one support offered to cancer patients and their families undergoing cancer treatment from trained volunteers who have survived cancer themselves.
BLOCH Cancer Hotline
Networks persons with cancer and home volunteers with same type of cancer. Free books about cancer.
6900 N Dallas Pkwy,
Plano, TX 75024
Good Days exists to improve the health and quality of life of patients battling chronic disease, cancer or other life-altering conditions who cannot afford the medications they so desperately need.
P.O. Box 4133
Gaithersburg, MD 20878
The HealthWell Foundation® provides full or partial financial assistance to eligible individuals who cannot afford their insurance co-payments, premiums, deductibles for certain treatments, and other out-of-pocket health care expenses.
Medicare & Medicaid
7500 Security Blvd
Baltimore, MD 21244-1850
Medicare is a federal system of health insurance for people over 65 years of age, and Medicaid assists low-income individuals and certain younger people with disabilities.
National Patient Advocate Foundation (NPAF)
725 15th St, NW, 10th Floor
Washington, DC 20005
NPAF provides professional case management services to individuals facing barriers to healthcare access for chronic and disabling disease, medical debt crisis and employment-related issues at no cost.
505 E 79th Street
New York, NY 10075
Joe’s House website lists thousands of places to stay across the country near hospitals and treatments centers that offer a discount for traveling patients and their loved ones.
Healthcare Hospitality Network, Inc.
P.O. Box 1439
Gresham, OR 97030
The Healthcare Hospitality Network, Inc. (HHN) is a nationwide professional association of nearly 200 unique, nonprofit organizations that provide lodging and support services to patients, families and their loved ones who are receiving medical treatment far from their home communities. The mission of HHN is to support homes that help and heal to be more effective in their service to patients and families.
Hope Lodge –American Cancer Society
Hope Lodge offers cancer patients and their caregivers a free, temporary place to stay when their best hope for effective treatment may be in another city. Currently, there are 31 Hope Lodge locations throughout the United States. Accommodations and eligibility requirements may vary by location.
National Lymphedema Network
116 New Montgomery Street, Suite 235
San Francisco, CA 94105
A non-profit organization founded in 1988 to provide education and guidance to lymphedema patients, health care professionals and the general public by disseminating information on the prevention and management of primary and secondary lymphedema.
Other Types of Melanoma
Oral Cancer Foundation
3419 Via Lido #205
Newport Beach, CA 92663
The Oral Cancer Foundation is a non-profit 501 (c) (3) public service charity that provides information, patient support, sponsorship of research and advocacy related to this disease. At the forefront of our agenda is to promote solid awareness in the minds of the American public about the need to undergo an annual oral cancer screening and an outreach to the dental community to provide this service as a matter of routine practice.
Ocular Melanoma Foundation
P.O. Box 29261
Richmond, VA 23242-0261
OMF aspires to be the top destination for up-to-date OM-related educational information, a meeting place, and advocacy resource. For doctors and researchers, OMF strives to be the connective tissue, facilitating interdisciplinary cancer research.
American Academy of Pain Management
The largest pain management organization in the nation and the only one that embraces an integrative model of care, which is patient-centered, focuses on the “whole” person, is informed by evidence, and brings together, all appropriate therapeutic approaches to reduce pain and achieve optimal health and healing. The Academy offers continuing education, publications, and advocacy.
American Chronic Pain Association
PO Box 850
Rocklin, CA 95677
Since 1980, the ACPA has offered peer support and education in pain management skills to people with pain, family and friends, and health care professionals. The information and tools on our site can help you to better understand your pain and work more effectively with your health care team toward a higher quality of life.
American Society of Radiation Oncology
8280 Willow Oaks Corporate Drive, Suite 500
703-502-1550 or 1-800-962-7876
Web site explains to patients, their families and the public how doctors called radiation oncologists use radiation therapy to treat cancer safely and effectively.
Radiation Therapy Fact Sheet
National Cancer Institute
A fact sheet that defines the different types of radiation therapy and discusses scientific advances that improve the effectiveness of this treatment.
This video was originally published by American Cancer Society on May 15, 2015, here.
Tom Crawford’s battle with melanoma has been a long one. He shares some of the wisdom he’s learned along the way.
This video was originally published by Cancer Support Community on August 24, 2015, here.
This video was originally published by Aim At Melanoma on Nov 4, 2014, here.
Skin samples taken by aor surgical are typically sent to a / laboratory for microscopic examination and diagnosis. A pathology report is issued by the pathologist or . The pathology report states the diagnosis and further describes many aspects of the appearance of the melanoma, including the type, depth of invasion, tissue level of invasion, presence or absence of a lymphatic response, presence or absence of , mitotic count, presence or absence of regression, presence or absence of satellite lesions, and presence or absence of blood vessel/lymphatic vessel/nerve invasion.
Additionally, the pathology report will describe whether the excisedis a primary melanoma, in which case it would be described using the terms above, or a deposit. A metastatic melanoma deposit is one in which the melanoma started somewhere else on the skin and some of the melanoma cells broke off and spread within the skin tissue to the current biopsy/specimen site.
Some Terms You May See on Your Pathology Report
Type of Melanoma (Histologic Subtype):
- Other: mucosal melanoma
- Other: uveal melanoma
Breslow Depth: Measurement in millimeters of how thick the primaryis, regardless of its . It is measured from the top layer of the skin to its deepest point.
Clark Level: Clark Level was replaced in the revised melanomasystem in 2010 by more reliably predictive features (mitotic count and ulceration). It is now only used to stage thin melanomas (< 1mm).
Radial Growth Phase (RGP): The melanoma lesion is described as either having RGP present or absent. If present, RGP is an indication that the melanoma is growing horizontally, or radially, within a single plane in the upper/superficial skin layers (mainly in the).
(VGP): The melanoma is described as either having VGP present or absent. If present, VGP is an indication that the melanoma is growing vertically, or deeper, into the tissues.
: TILs describe the patient’s to the melanoma. When the pathologist examines the melanoma under the microscope, he/she looks to see whether or not there are lymphocytes within the melanoma. The amount of invasion/response to the melanoma is described as brisk (a lot of lymphocytes), nonbrisk (some), sparse (few) or absent (none), although occasionally it can be described as mild or moderate. TILs appear to indicate that your has recognized the melanoma cells as abnormal and is trying to move into the melanoma to attack it. Some studies suggest that the presence of increasing number of TILs may be associated with a better .
Ulceration: Ulceration is described as being present or absent. It is the breakdown or loss of the top layer of cells in a melanoma and often occurs in the center of a tumor. The presence of ulceration increases the stage classification of a melanoma. Ulceration is thought to reflect rapid tumor growth, leading to the death of cells in the center of the melanoma and thus is associated with a worse prognosis. The pathologist can determine whether ulceration is present or absent when they review the biopsy under the microscope.
Regression: Regression is described as an area of the tumor without active melanomagrowth and is described as present or absent. If it is present, the extent of regression is estimated… When regression is present, the measured of the melanoma may not be the greatest/true thickness.
Mitotic Count (Mitotic Rate): Mitosis is the process by which one mature cell divides into two identical cells. When pathologists study melanoma, they will count the number of actively dividing cells that they see. Averaging this number gives the mitotic count and it is reported as the number ofper square millimeter (mm2), (example ≤1 mitoses/mm2). A high mitotic count means more tumor cells are dividing at a given time and is associated with a worse prognosis.
Satellites: Satellite lesions are small nodules of tumor/melanoma located more than 0.05mm from the primary lesion, but less than 2cm. Satellites are described as being present or absent. Some satellite lesions (macroscopic) can be seen with the naked eye. Others, which are smaller (microscopic) can be found only by the pathologists. Both macroscopic and microscopic lesions are reported in the pathology report.
Blood Vessel/Lymphatic Invasion: Blood vessel invasion, also called angioinvasion, or lymphatic vessel invasion, is described as being present or absent. If present, it means that the melanoma has invaded the blood orand is associated with more aggressively growing melanomas.
This video was originally published by Aim At Melanoma on November 4, 2014, here.
Tips to reduce your risk of developing melanoma:
Make sunscreen a daily habit. UV radiation can still damage skin even in the winter and on cloudy days.
Use a broad-spectrum sunscreen (protects against UVA and UVB rays) with SPF of at least 30.
Wear Protective Clothing.
Protect your body with sun-protective clothing, hat, and sunglasses.
Avoid Peak Rays. Seek shade during the mid-day sun, when the sun’s rays are most intense.
Don’t Use Tanning Beds. Indoor tanning has been shown to increase the risk of melanoma by up to 75%. Melanoma is one of the top three cancers diagnosed in young adults (ages 25-29), and scientists attribute this trend to the use of tanning beds among this age group, particularly young women.
Protect Your Children. Just one bad sunburn in childhood or adolescence doubles your child’s chances of developing melanoma later in life.
Melanoma Risk Factors: People with the following traits are at higher risk for developing melanoma and other skin cancers:
Fair skin, red or blonde hair light eyes, more than 50 moles, history of sunburn or UV exposure, family history of skin cancer, and personal history of skin cancer.
This video was originally published by OncLiveTV on August 21, 2019, here.
This video was originally published by Aim at Melanoma here.
This video was originally published by The Mayo Clinic on Aug 7, 2017, here.
Melanoma develops in the cells that produce your skin’s pigment and is the most serious type of skin cancer. However, when it’s detected early, melanoma can be effectively treated. The ABCDE melanoma test can help you identify the warning signs of cancer.
This resource was originally published by the American Cancer Society here.
Most melanomas are brought to a doctor’s attention because of signs or symptoms a person is having.
If you have an abnormal area on your skin that might be cancer, your doctor will examine it and might do tests to find out if it is melanoma, another type of skin cancer, or some other skin condition. If melanoma is found, other tests may be done to find out if it has spread to other areas of the body.
Medical history and physical exam
Usually the first step your doctor takes is to ask about your symptoms, such as when the mark on the skin first appeared, if it has changed in size or appearance, and if it has been painful, itchy, or bleeding. You may also be asked about your possible risk factors for melanoma skin cancer, such as your history of tanning and sunburns, and if you or anyone in your family has had melanoma or other skin cancers.
During the physical exam, your doctor will note the size, shape, color, and texture of the area(s) in question, and whether it is bleeding, oozing, or crusting. The rest of your body may be checked for moles and other spots that could be related to skin cancer (or other skin conditions).
The doctor may also feel the lymph nodes (small, bean-sized collections of immune cells) under the skin in the neck, underarm, or groin near the abnormal area. When melanoma spreads, it often goes to nearby lymph nodes first, making them larger.
If you are being seen by your primary doctor and melanoma is suspected, you may be referred to a dermatologist, a doctor who specializes in skin diseases, who will look at the area more closely.
Along with a standard physical exam, many dermatologists use a technique called dermoscopy (also known as dermatoscopy, epiluminescence microscopy [ELM], or surface microscopy) to see spots on the skin more clearly. The doctor uses a dermatoscope, which is a special magnifying lens and light source held near the skin. Sometimes a thin layer of alcohol or oil is used with this instrument. The doctor may take a digital photo of the spot.
If the doctor thinks a spot might be a melanoma, the suspicious area will be removed and sent to a lab to be looked at under a microscope. This is called a skin biopsy.
There are many ways to do a skin biopsy. The doctor will choose one based on the size of the affected area, where it is on your body, and other factors. Any biopsy is likely to leave at least a small scar. Different methods can result in different types of scars, so ask your doctor about scarring before the biopsy. No matter which type of biopsy is done, it should remove as much of the suspected area as possible so that an accurate diagnosis can be made.
Skin biopsies are done using a local anesthetic (numbing medicine), which is injected into the area with a very small needle. You will likely feel a small prick and a little stinging as the medicine is injected, but you should not feel any pain during the biopsy.
Shave (tangential) biopsy
For this type of biopsy, the doctor shaves off the top layers of the skin with a small surgical blade. Bleeding from the biopsy site is stopped by applying an ointment, a chemical that stops bleeding, or a small electrical current to cauterize the wound.
A shave biopsy is useful in diagnosing many types of skin diseases and in sampling moles when the risk of melanoma is very low. This type of biopsy is not generally used if a melanoma is strongly suspected unless the biopsy blade will go deep enough to get below the suspicious area. Otherwise, if it is a melanoma, the biopsy sample may not be thick enough to measure how deeply the cancer has invaded the skin.
For a punch biopsy, the doctor uses a tool that looks like a tiny round cookie cutter to remove a deeper sample of skin. The doctor rotates the punch biopsy tool on the skin until it cuts through all the layers of the skin. The sample is removed and the edges of the biopsy site are often stitched together.
Excisional and incisional biopsies
To examine a tumor that might have grown into deeper layers of the skin, the doctor may use an excisional (or less often, an incisional) biopsy.
- An excisional biopsy removes the entire tumor (along with a small margin of normal skin around it). This is usually the preferred method of biopsy for suspected melanomas if it can be done, although this isn’t always possible.
- An incisional biopsy removes only a portion of the tumor.
For these types of biopsies, a surgical knife is used to cut through the full thickness of skin. A wedge or sliver of skin is removed for examination, and the edges of the cut are usually stitched together.
Some newer types of biopsies, such as reflectance confocal microscopy (RCM), can be done without needing to remove samples of skin. To learn more, see What’s New in Melanoma Skin Cancer Research?
Biopsies of melanoma that may have spread
Biopsies of areas other than the skin may be needed in some cases. For example, if melanoma has already been diagnosed on the skin, nearby lymph nodes may be biopsied to see if the cancer has spread to them.
Rarely, biopsies may be needed to figure out what type of cancer someone has. For example, some melanomas can spread so quickly that they reach the lymph nodes, lungs, brain, or other areas while the original skin melanoma is still very small. Sometimes these tumors are found with imaging tests (such as CT scans) or other exams even before the melanoma on the skin is discovered. In other cases, they may be found long after a skin melanoma has been removed, so it’s not clear if it’s the same cancer.
In still other cases, melanoma may be found somewhere in the body without ever finding a spot on the skin. This may be because some skin lesions go away on their own (without any treatment) after some of their cells have spread to other parts of the body. Melanoma can also start in internal organs, but this is very rare, and if melanoma has spread widely throughout the body, it may not be possible to tell exactly where it started.
When melanoma has spread to other organs, it can sometimes be confused with a cancer starting in that organ. For example, melanoma that has spread to the lung might be confused with a primary lung cancer (cancer that starts in the lung).
Special lab tests can be done on the biopsy samples that can tell whether it is a melanoma or some other kind of cancer. This is important because different types of cancer are treated differently.
Biopsies of suspicious areas inside the body often are more involved than those used to sample the skin.
Fine needle aspiration (FNA) biopsy
FNA biopsy is not used on suspicious moles. But it may be used, for example, to biopsy large lymph nodes near a melanoma to find out if the melanoma has spread to them.
For this type of biopsy, the doctor uses a syringe with a thin, hollow needle to remove very small pieces of a lymph node or tumor. The needle is smaller than the needle used for a blood test. A local anesthetic is sometimes used to numb the area first. This test rarely causes much discomfort and does not leave a scar.
If the lymph node is just under the skin, the doctor can often feel it well enough to guide the needle into it. For a suspicious lymph node deeper in the body or a tumor in an organ such as the lung or liver, an imaging test such as ultrasound or a CT scan is often used to help guide the needle into place.
FNA biopsies are not as invasive as some other types of biopsies, but they may not always collect enough of a sample to tell if a suspicious area is melanoma. In these cases, a more invasive type of biopsy may be needed.
Surgical (excisional) lymph node biopsy
This procedure can be used to remove an enlarged lymph node through a small incision (cut) in the skin. A local anesthetic (numbing medicine) is generally used if the lymph node is just under the skin, but the person may need to be sedated or even asleep (using general anesthesia) if the lymph node is deeper in the body.
This type of biopsy is often done if a lymph node’s size suggests the melanoma has spread there but an FNA biopsy of the node wasn’t done or didn’t find any melanoma cells.
Sentinel lymph node biopsy
If melanoma has been diagnosed and has any concerning features (such as being at least a certain thickness), a sentinel lymph node biopsy (SLNB) is often done to see if the cancer has spread to nearby lymph nodes, which in turn might affect treatment options. This test can be used to find the lymph nodes that are likely to be the first place the melanoma would go if it has spread. These lymph nodes are called sentinel nodes (they stand sentinel, or watch, over the tumor, so to speak).
To find the sentinel lymph node (or nodes), a doctor injects a small amount of a radioactive substance into the area of the melanoma. After giving the substance time to travel to the lymph node areas near the tumor, a special camera is used to see if it collects in one or more sentinel lymph nodes. Once the radioactive area has been marked, the patient is taken for surgery, and a blue dye is injected in the same place the radioactive substance was injected. A small incision is then made in the marked area, and the lymph nodes are then checked to find which one(s) became radioactive and turned blue. These sentinel nodes are removed and looked at under a microscope.
If there are no melanoma cells in the sentinel nodes, no more lymph node surgery is needed because it is very unlikely the melanoma would have spread beyond this point. If melanoma cells are found in the sentinel node, the remaining lymph nodes in this area are typically removed and looked at as well. This is known as a lymph node dissection (see Surgery for Melanoma Skin Cancer).
If a lymph node near a melanoma is abnormally large, a sentinel node biopsy probably won’t be needed. The enlarged node is simply biopsied.
Lab tests of biopsy samples
Samples from any biopsies will be sent to a lab, where a doctor called a pathologist will look at them under a microscope for melanoma cells. Often, skin samples are sent to a dermatopathologist, a doctor who has special training in looking at skin samples.
If the doctor can’t tell for sure if melanoma cells are in the sample just by looking at it, special lab tests will be done on the cells to try to confirm the diagnosis. These might include:
- Immunohistochemistry (IHC)
- Fluorescence in situ hybridization (FISH)
- Comparative genomic hybridization (CGH)
- Gene expression profiling (GEP)
If melanoma is found in the samples, the pathologist will look at certain important features such as the tumor thickness and mitotic rate (the portion of cells that are actively dividing). These features help determine the stage of the melanoma (see Melanoma Skin Cancer Stages), which in turn can affect treatment options and prognosis (outlook).
Testing for gene changes
For some people with melanoma, biopsy samples may be tested to see if the cells have mutations (changes) in certain genes, such as the BRAF gene. About half of melanomas have BRAF mutations. Some drugs used to treat advanced melanomas are only likely to work if the cells have BRAF mutations (see Targeted Therapy for Melanoma Skin Cancer), so this test is important in helping to determine treatment options. Tests for changes in other genes, such as C-KIT, might be done as well.
A newer lab test known as DecisionDx-Melanoma looks at certain gene expression patterns in melanoma cells to help show if early-stage melanomas are likely to spread. This might be used to help determine treatment options. To learn more, see What’s New in Melanoma Skin Cancer Research?
Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of the body. They are used mainly to look for the possible spread of melanoma to lymph nodes or other organs. These tests are not needed for most people with very early-stage melanoma, which is very unlikely to have spread.
Imaging tests can also be done to help determine how well treatment is working or to look for possible signs of cancer coming back (recurring) after treatment.
This test might be done to help determine if melanoma has spread to the lungs, although a CT scan of the chest (see below) is often done instead.
Ultrasound uses sound waves to create images of the inside of your body on a computer screen. This test might be used to look at the lymph nodes near the tumor, especially if it’s not clear if they’re enlarged based on a physical exam. Ultrasound is typically fairly quick and easy to do, and it doesn’t expose you to radiation.
Ultrasound-guided needle biopsy: Ultrasound can also be used to help guide a biopsy needle into a suspicious lymph node.
Computed tomography (CT) scan
The CT scan uses x-rays to make detailed, cross-sectional images of your body. Unlike a regular x-ray, CT scans can show the detail in soft tissues (such as internal organs). This test can show if any lymph nodes are enlarged or if organs such as the lungs or liver have suspicious spots, which might be from the spread of melanoma.
CT-guided needle biopsy: CT scans can also be used to help guide a biopsy needle into a suspicious area within the body.
Magnetic resonance imaging (MRI) scan
MRI scans use radio waves and strong magnets instead of x-rays to create detailed images of parts of your body. MRI scans can be very helpful in looking at the brain and spinal cord.
Positron emission tomography (PET) scan
A PET scan can help show if the cancer has spread to lymph nodes or other parts of the body. It is most useful in people with more advanced stages of melanoma.
For this test, you are injected with a slightly radioactive form of sugar, which collects mainly in cancer cells. A special camera is then used to create a picture of areas of radioactivity in the body.
PET/CT scan: Many centers have special machines that do both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT scan.
Blood tests aren’t used to diagnose melanoma, but some tests may be done before or during treatment, especially for more advanced melanomas.
Doctors often test blood for levels of a substance called lactate dehydrogenase (LDH) before treatment. If the melanoma has spread to distant parts of the body, a high LDH level is a sign that the cancer may be harder to treat. This can affect the stage of the cancer (see Melanoma Skin Cancer Stages).
Other tests of blood cell counts and blood chemistry levels may be done in a person who has advanced melanoma to see how well the bone marrow (where new blood cells are made), liver, and kidneys are working before and during treatment.
Last Medical Review: August 14, 2019 Last Revised: August 14, 2019