If You Have Melanoma Skin Cancer

What is melanoma?

Cancer can start any place in the body. Melanoma is a kind of skin cancer that starts when skin cells called melanocytes grow out of control.

Cancer cells can spread to other parts of the body and grow there. When cancer cells do this, it’s called metastasis. To doctors, the cancer cells in the new place look just like the ones that started in the skin.

Cancer is always named based on the place where it starts. So when melanoma skin cancer spreads to any other organ, it’s still called melanoma.

Ask your doctor to use this picture to show you where your cancer is

What is a melanocyte?

Melanocytes are cells in the skin. They make a brown pigment called melanin, which makes the skin brown or tan.

Are there different kinds of skin cancer?

There are many types of skin cancer. Your doctor can tell you more about the type of skin cancer you have.

Basal cell and squamous cell skin cancers are much more common than melanoma and don’t often spread to other parts of the body. Melanoma is more deadly because it is more likely to spread to other parts of the body.

Questions to ask the doctor

• Why do you think I have cancer?
• Is there a chance I don’t have cancer?
• Would you please write down the kind of cancer you think I might have?
• What will happen next?

How does the doctor know I have melanoma?

A new spot on your skin or a spot that’s changing in size, shape, or color may be a warning sign of melanoma. If you have any of these changes, have your skin checked by a doctor.

The doctor will ask you questions about when the spot on your skin first showed up and if it has changed in size or the way it looks. The rest of your skin will be checked. During the exam your doctor will check the size, shape, color and texture of any skin changes. If signs are pointing to melanoma, more tests will be done.

Tests that might be done

Biopsy: In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have skin cancer and what kind it is. There are many types of skin biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.

Lab tests of biopsy samples: If melanoma is found, lab tests might be done on the cancer cells to see if they have certain gene changes. This might affect your treatment options.

Chest x-ray: This test may be done to see if the melanoma has spread to your lungs.

Ultrasound: This test uses sound waves and their echoes to make pictures of the inside of your body. Ultrasound might be used to look at lymph nodes (small collections of immune cells) near the tumor to see if the cancer has spread there.

CT or CAT scan: This test uses x-rays to make detailed pictures of your insides. A CT scan may be used to see if nearby lymph nodes are swollen or if organs like the lungs or liver have spots that might be from the spread of melanoma. If any spots are found, a CT scan might be used to guide a needle into the spots to do a biopsy.

MRI scan: This test uses radio waves and strong magnets instead of x-rays to make detailed pictures of your insides. It's very good for looking at the brain and spinal cord. This test can help show if the cancer has spread.

PET scan: PET scans use a special kind of sugar that can be seen inside your body with a special camera. If there’s cancer, this sugar shows up as “hot spots” where the cancer is found. This test can help show if and where the cancer has spread.

Questions to ask the doctor

• What tests will I need?
• Who will do these tests?
• Where will they be done?
• Who can explain them to me?
• How and when will I get the results?
• Who will explain the results to me?
• What do I need to do next?

How serious is my cancer?

If you have melanoma, the doctor will want to find out how far it has spread. This is called staging. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the growth or spread of the melanoma through the skin. It also tells if it has spread to other parts of your body.

Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the skin. Be sure to ask the doctor about the cancer stage and what it means for you.

Questions to ask the doctor

• Do you know the stage of the cancer?
• If not, how and when will you find out the stage of the cancer?
• Would you explain to me what the stage means in my case?
• Based on the stage of melanoma, how long do you think I’ll live?
• What will happen next?

What kind of treatment will I need?

There are many ways to treat melanoma. The main types of treatment are:

• Surgery
• Immunotherapy
• Targeted therapy
• Chemotherapy
• Radiation

Most early stage melanomas can be treated with surgery alone. More advanced cancers need other treatments.

The treatment plan that’s best for you will depend on:

• The stage of the cancer
• The results of lab tests on the cancer cells
• The chance that a type of treatment will cure the melanoma or help in some way
• Your age
• Other health problems you have
• Your feelings about the treatment and the side effects that come with it

Surgery

Surgery is the main treatment for most melanomas. It can often cure early-stage melanomas. There are different kinds of surgery. The type that’s best for you depends on how large the melanoma is and where it is. Ask your doctor what kind of surgery you will have and what to expect.

Side effects of surgery

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat people with melanoma should be able to help you with any problems that come up.

Immunotherapy

Immunotherapy is treatment that boosts your own immune system to attack the melanoma cells. Many types of immunotherapy are used to treat melanoma. These drugs may be given into a vein, given as a shot, or taken as pills.

Side effects of immunotherapy

Immunotherapy can cause many different side effects, depending on which drug is used. Some of these drugs might make you feel tired, sick to your stomach, and cause fever, chills, and rashes. Most of these problems go away after treatment ends.

There are ways to treat most of the side effects from immunotherapy. If you have side effects, talk to your cancer care team so they can help.

Targeted therapy

Targeted therapy drugs may be used for certain types of melanoma. These drugs affect mainly cancer cells and not normal cells in the body. They may work even if other treatment doesn’t. They may cause fewer side effects.

Chemo

Chemo is the short word for chemotherapy – the use of drugs to fight cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body. They kill cells that are fast growing cancer cells and good cells like blood cells and hair. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

Side effects of chemo

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.

There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.

Radiation treatments

Radiation uses high-energy rays (like x-rays) to kill cancer cells. Radiation is not usually used to treat the main spot on the skin. But it may be used after surgery to help keep the melanoma from coming back.

Side effects of radiation treatments

If your doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the part of the body that’s treated. The most common side effects of radiation are:

• Sunburn-like skin changes where the radiation is given
• Hair loss where the radiation enters the body
• Feeling very tired (fatigue)

Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect.

Clinical trials

Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials. See Clinical Trials to learn more.

What about other treatments I hear about?

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor

• How far has the melanoma spread under my skin?
• Has it spread anywhere else?
• What treatment do you think is best for me?
• What’s the goal of this treatment? Do you think it could cure the cancer?
• Will treatment include surgery? If so, who will do the surgery?
• What will the surgery be like?
• Will I need other types of treatment, too?
• What’s the goal of these treatments?
• What side effects could I have from these treatments?
• What can I do about side effects that I might have?
• Is there a clinical trial that might be right for me?
• What about special vitamins or diets that friends tell me about? How will I know if they are safe?
• How soon do I need to start treatment?
• What should I do to be ready for treatment?
• Is there anything I can do to help the treatment work better?
• What’s the next step?

What will happen after treatment?

You’ll be glad when treatment is over. For years after treatment, you will see your cancer doctor. Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back.

At first, your visits may be every few months. Then, the longer you’re cancer-free, the less often the visits are needed. After 5 years, they may be done once a year.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.

You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.