Managing melanoma

How to avoid, identify or deal with melanoma


Did you know Australia and New Zealand have the highest rates of skin cancer in the world?  The Australian incidence of melanoma is 12 times the global average rate1. Melanoma is the third most common form of cancer for Australian men and women, and the most common cause of cancer for Australians aged between 15 and 441.

What exactly is melanoma?

Melanoma starts in a certain type of skin cell. Typically, it develops as a growth of abnormal melanocyte cells. These are the cells that produce the pigment melanin that colours the skin, hair and eyes, and which often form moles.

Problems can arise when melanocytes are over-exposed to ultraviolet (UV) rays, for example through sunburn. While sunburn goes away, the effect of UV radiation is cumulative. That is, the more someone exposes their skin to the harsh Australian sun over the years, the higher their risk of melanoma.

Somewhat confusingly, melanoma can also occur in parts of the body not exposed to the sun, such as under fingernails or toenails. Given melanocytes are found in the eye, heart, bowel, inner ear, bones and membranes of the central nervous system, they too are at risk of melanoma.

The four types of melanoma

There are three types of skin cancer: basal cell carcinoma (the most common but least dangerous variety), squamous cell carcinoma (which chiefly afflicts older people) and melanoma. Melanomas fall into four categories:

  1. Superficial spreading melanoma (SSM) is the most common type. It's usually identified on the upper back as a slow-growing lesion. It can appear symmetrical in shape, with uneven borders and in a mixture of colours – brown, blue and black or red with grey regions.
  2. Nodular melanoma is the second most common type. It's fast growing and usually appears on the chest, back, head or neck. It can either ulcerate and bleed, or present as a red, pink or black dome-shaped lump.
  3. Lentigo maligna melanoma (LMM) usually occurs in older people. It tends to develop in sun-exposed areas such as the face and forearms. It appears as changing, pigmented lesions and develops from a slow-growing lesion called the lentigo maligna (also known as Hutchison's freckle).
  4. Acral Lentiginous Melanoma (ALM) usually occurs in males over 60 or in dark-skinned people. It often appears on the sole of the foot, palm of the hand, finger or toenail, mouth, genitals or anus.

Watch out for these warning signs

Melanoma advances in five stages. Each is defined by how deeply it has grown into the skin and whether it has spread to other areas of the body, such as the lymph nodes. Melanomas are usually seen far earlier than they are felt. The first sign of a melanoma is usually a change to a current mole or the appearance of a new spot, which is why it’s so important to keep an eye on the state of your skin.

The four red flags to look out for are:

  1. a change in the size or shape of any mole, freckle or spot
  2. a change in the colour tone of a mole that has suddenly become blotchy with a wide variety of colours
  3. a spot that has become itchy or bleeds easily
  4. a skin spot that appears different to others on your skin, especially if it has an irregular edge or lack of symmetry.

If you notice any suspicious lumps or bumps, don't hesitate to consult your doctor.

Melanoma is the third most common form of cancer for Australian men and women, and the most common cause of cancer for Australians aged between 15 and 44.

Unsurprisingly, the fair-complexioned are at most risk of developing all three types of skin cancer, though people of any skin colour can and do develop melanomas. Those with multiple moles, a weakened immune system, a previous history of skin cancer or a family history of melanoma are also at greater risk of melanoma.

What should I ask my doctor?

The unfortunate reality is that melanoma is the most serious skin cancer and can be fatal. That noted, today survival rates are the highest they have ever been. If diagnosed early, nearly all melanomas can be successfully treated. If you are diagnosed with a melanoma, ask your doctor the following questions to ensure you have all the key information about your condition and what to do next.

  • Has my melanoma spread?
  • Do I need any other tests?
  • What are my treatment options? What are the risks and benefits of each?
  • Do I need any other tests?
  • Which treatment do you recommend?
  • What is the goal of this treatment?
  • How quickly do I need to decide on treatment?
  • How long will treatment last?
  • What will it be like?
  • How will treatment affect my daily activities?
  • What type of side effects are normal?
  • Will I have a scar after treatment?
  • What are the chances of my cancer growing or recurring?
  • What would we do if this occurs?
  • What special precautions do I need to take in the sun?
  • Are my family members at risk of skin cancer?
  • What should I tell them to do?
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