Melanoma Stages

The distinguishing characteristic of melanoma is uncontrolled growth of melanocytes. These cells produce melanin, which is one of the body’s coloring agents. Most melanomas have a black or blue-black color, and they appear abnormal and even ugly.

The Skin Cancer Foundation promotes the A-B-C-D-E method of identifying potential melanomas.

• A—Asymmetry. One-half of the lesion does not match the other half.
• B—Border. Ragged, notched, blurred, or otherwise irregular.
• C—Color. Not uniform and could include shades of brown, black, and tan, with streaks of red, white, or blue.
• D—Diameter. More than six millimeters (about one quarter-inch) when diagnosed, but possibly smaller.
• E—Evolving. Change in size, shape, color, or thickness, or beginning to itch, bleed, and form a crust.

Diagnosis

Early detection and treatment is key. The deeper a melanoma has penetrated, the deadlier it becomes. In other words, the higher the melanoma stages become, the lower the survival rate. If it reaches beyond lymph nodes in the immediate area, the five-year survival rate is only 18 percent. A medical history, biopsies, and imaging tests are used to diagnose melanomas. They are classified and treated according to stages of development.

Survival Rates

Five-year survival rates depend on the stage. The rates vary from 99 percent for patients at stage 0 to 10-15 percent at stage 4.

Treating It

Early stage melanomas can be removed by simple procedures at a dermatologist’s office. In some cases, the entire area can be cut out during a biopsy without further treatment.

Melanomas that have spread beyond the surface of the skin are more difficult to treat. In Mohs micrographic surgery, the surgeon uses a microscope to examine the tissue and excises the growth layer by layer until only healthy tissue remains.

Medications

Chemotherapy, in pill or intravenous form, destroys cancer cells for several months, but the treatment does not yet have a record of curing melanomas.

Other “targeted” drugs attack genetic mutations in the BRAF gene, which account for about one-half of all melanomas. Drugs that target the BRAF protein are not likely to be effective in patients who have a normal BRAF gene.

Using a combination of drugs has become an effective treatment method. UCLA researchers found that two drugs (dabrafenib and trametinib) combined with immunotherapy were more effective than the current standard treatment.

In another study, a combination of ipilimumab and nivolumab improved more than 70 percent of melanoma patients.

Radiation

Radiation can kill cancer cells, including those produced in melanoma, but it is not considered a cure because it is not always 100 percent successful.

Immunotherapy

Immunotherapy therapy is an attempt to stimulate a person’s immune system to kill a malignancy. Two types have received most of the attention and funding.

Checkpoint inhibitors block the ability of certain proteins to weaken the response of the immune system so that it cannot recognize abnormal cells.

CAR T-cell therapy involves removing T cells, genetically modifying them to target a specific cancer, and infusing back into the patient.

Preventing Melanoma

You can lower your risk of melanoma by taking these precautions:

• Use a sunscreen with a sun protection factor (SPF) of 30 to 50.
• Avoid unnecessary exposure to the sun.
• Wear clothes that protect your arms, legs, face, neck, and ears.
• Conduct monthly self-exams.
• Schedule an annual exam with a dermatologist.