Dr. Jeffrey Berti and Dr. Toula Berti specialize in advanced treatment of all skin disorders for men, women and children. In addition, the physicians at Dermatology & Dermatologic Surgery, Ltd. also offer a number of procedures for skin rejuvenation and body contouring.
Also called malignant melanoma
Melanoma is the most serious type of skin cancer. Allowed to grow, melanoma can spread quickly to other parts of the body. This can be deadly.
There is good news. When found early, melanoma is highly treatable.
You can find melanoma early by following this 3-step process:
Images property of the American Academy of Dermatology.
Melanoma, the deadliest skin cancer, can show up on your body in different ways. You may see a:
Dermatologists encourage people of all skin colors to perform skin self-exams. Checking your skin can help you find melanoma early when it’s highly treatable. When examining your skin for melanoma, you want to look for the warning signs, which are called the ABCDEs of melanoma :
You can have melanoma without feeling any pain or discomfort. For many people, the only sign is a change to their skin, scalp, or nail.
Sometimes, melanoma causes one of more of the following:
When checking your skin, you want to make sure you check everywhere.
Images 1, 3, and 4 used with permission of the Journal of the American Academy of Dermatology:
Images 2, 4, and 5: Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
Image 7: Property of the American Academy of Dermatology
Agbai ON, MD, Buster K, et al. “Skin cancer and photoprotection in people of color: A review and recommendations for physicians and the public.” J Am Acad Dermatol 2014;70(4):748-62.
Gagnon, L. “Dermatologists better at detecting melanoma
Non-dermatologists would benefit from more training in accurate pigmented lesion diagnosis.” Dermatology Times. Jan 12, 2015:
Gloster HM and Neal K. “Skin cancer in skin of color.” J Am Acad Dermatol 2006;55(5):741-60.
Tsao H, Olazagasti JM, et al. “Early detection of melanoma: Reviewing the ABCDEs.” J Am Acad Dermatol 2015;72:717-23.
Anyone can get melanoma. Most people who get melanoma have light skin, but people who have brown and black skin also get melanoma.
Your risk of getting melanoma increases if you:
Seek the sun, tanning beds, or sun lamps: The sun, tanning beds, and sun lamps emit ultraviolet light (UV). Scientists have proven that UV light can cause skin cancer in people. Their research also shows you increase your risk of getting melanoma if you:
While exposure to UV light greatly increases your risk of developing melanoma, your other characteristics also play a role. These include:
Having light-colored skin, hair, or eyes or certain moles: The risk of getting melanoma increases if you have one or more of the following:
Taking certain medications or having some medical conditions: Your risk of getting melanoma increases if you have:
Have a history of melanoma in your family: If a close blood relative has or had melanoma, you have a higher risk of getting melanoma.
Ultraviolet (UV) light causes melanoma. We get UV light from the sun and tanning beds. Scientists have shown that UV light from the sun and tanning beds can do two things:
Scientists have also found that some people inherit genes that increase their risk of getting melanoma.
Because UV exposure is the leading cause of melanoma, you can greatly reduce your risk of getting melanoma by taking steps to prevent skin cancer.
American Academy of Dermatology. Stats and facts: Melanoma. Last accessed April 27, 2016.
Soura E, Eliades PJ, et al. “Hereditary melanoma: Update on syndromes and management Emerging melanoma cancer complexes and genetic counseling.” J Am Acad Dermatol 2016;74:411-20.
Zwald FO and Brown M. “Skin cancer in solid organ transplant recipients: Advances in therapy and management Part I. Epidemiology of skin cancer in solid organ transplant recipients.” J Am Acad Dermatol 2011;65:253-61.
To diagnose melanoma, a dermatologist begins by looking at the patient’s skin. A dermatologist will carefully examine moles and other suspicious spots. To get a better look, a dermatologist may use a device called a dermoscope. The device shines light on the skin. It magnifies the skin. This helps the dermatologist to see pigment and structures in the skin.
The dermatologist also may feel the patient’s lymph nodes. Many people call these lymph glands.
If the dermatologist finds a mole or other spot that looks like melanoma, the dermatologist will remove it (or part of it). The removed skin will be sent to a lab. Your dermatologist may call this a biopsy. Melanoma cannot be diagnosed without a biopsy.
This biopsy is quick, safe, and easy for a dermatologist to perform. This type of biopsy should not cause anxiety. The discomfort and risks are minimal.
If the biopsy report says that the patient has melanoma, the report also may tell the stage of the melanoma. Stage tells the doctor how deeply the cancer has grown into the skin.
The melanoma stages are:
Melanoma is confined to the epidermis (top layer of skin).
|Stage I||Melanoma is confined to the skin, but has grown thicker. It can be as thick as 1.0 millimeter. In stage IA, the skin covering the melanoma remains intact. In stage IB, the skin covering the melanoma has broken open (ulcerated).
|Stage II||Melanoma has grown thicker. The thickness ranges from 1.01 millimeters to greater than 4.0 millimeters. The skin covering the melanoma may have broken open (ulcerated). While thick, the cancer has not spread.
|Stage III||Melanoma has spread to either: 1) one or more nearby lymph node (often called lymph gland) or 2) nearby skin.
|Stage IV||Melanoma has spread to an internal organ, lymph nodes further from the original melanoma, or is found on the skin far from the original melanoma.|
Sometimes the patient needs another type of biopsy. A type of surgery called a sentinel lymph node biopsy (SLNB) may be recommended to stage the melanoma. When melanoma spreads, it often goes to the closest lymph nodes first. A SLNB tells doctors whether the melanoma has spread to nearby lymph nodes. Other tests that a patient may need include x-rays, blood work, and a CT scan.
The type of treatment a patient receives depends on the following:
The following describes treatment used for melanoma.
Surgery: When treating melanoma, doctors want to remove all of the cancer. When the cancer has not spread, it is often possible for a dermatologist to remove the melanoma during an office visit. The patient often remains awake during the surgical procedures described below. These procedures are used to remove skin cancer:
When caught early, removing the melanoma by excision or Mohs may be all the treatment a patient needs. In its earliest stage, melanoma grows in the epidermis (outer layer of skin). Your dermatologist may refer to this as melanoma in situ or stage 0. In this stage, the cure rate with surgical removal is nearly 100%.
When melanoma grows deeper into the skin or spreads, treatment becomes more complex. It may begin with one of the surgeries described above. A patient may need more treatment. Other treatments for melanoma include:
Other treatment that may be recommended includes:
This depends on how deeply the melanoma has grown into the skin. If the melanoma is properly treated when it is in the top layer of skin, the cure rate is nearly 100%. If the melanoma has grown deeper into the skin or spread, the patient may die.
Have you been diagnosed with melanoma? Are you going through treatment?
If you feel stressed about your diagnosis or treatment, it can be difficult to listen. Too often, our minds just wander. This can make it challenging to understand medical information and instructions.
Good two-way communication, however, is important. Studies show that effective communication between a patient and doctor during cancer care can improve results.
The following tips can help you get the information you need. These tips can also help make sure you give your dermatologist essential information.
You can improve communication by telling your dermatologist the following about yourself.
When we're stressed, it can be difficult to remember what we hear. The following tips can help you get the information you need.
Before leaving, it's important to know what you need to do next. Taking a minute to do the following can help.
You probably have a lot on your mind now. By bookmarking or printing this page, you'll be able to refer to these tips during your appointments. (7.8, 598)
National Cancer Institute. “Communication in Cancer Care (PDQ®)–Patient Version.” Last update March 27, 2015. Last accessed June 27, 2016
March 2015: Treatment for advanced melanoma is changing rapidly. Breakthroughs in medical research are giving hope to patients who have melanoma that has spread.
Fueling this change is a type of treatment called targeted therapy. This therapy uses new drugs that can temporarily shrink the cancer.
Breakthroughs in another type of treatment called immunotherapy, which helps the patient’s immune system fight cancer, also are helping some patients live longer.
The following explains how these new drugs, approved by the U.S. Food and Drug Administration (FDA) between 2011 and 2014, are helping patients. All have been approved to treat adults (18 years or older) who have melanoma that has spread.
Ipilimumab (Yervoy®), which was FDA approved in 2011, is helping some people with advanced melanoma live longer.
How ipilimumab works: This drug helps the patient’s immune system to recognize, target, and attack cancer cells. Healthy cells are left alone.
Patient responses to ipilimumab: In studies, patients had the following response:
Encouraging news: Giving patients ipilimumab and another drug that boosts the immune system can increase a patient’s response. In clinical trials, the patients receiving such combinations live longer and have fewer toxic side effects than patients who receive only ipilimumab.
How to take ipilimumab: Patients receive IV drips at a hospital or cancer treatment center.
Note: A medical oncologist (doctor who specializes in treating cancer) usually treats patients when melanoma spreads. This doctor can tell you how often you would take this drug and possible side effects.
Pegylated interferon: Another advance in immunotherapy is the FDA approval of pegylated (or peg) interferon to treat melanoma that has spread to nearby lymph nodes. Peg-interferon causes fewer side effects than interferon given in the past. This may help patients take the drug for a longer time. The recommended treatment period is 5 years.
Cancer begins when changes take place within our genes. Your doctor may call these changes “gene mutations.”
Some people with melanoma have changes to a specific gene called BRAF. Doctors often refer to this change as a “BRAF gene mutation.”
Researchers have developed drugs that can target a BRAF gene mutation. The following drugs are FDA approved to treat melanoma driven by a BRAF gene mutation:
How these drugs works: If a patient has a certain BRAF gene mutation, these drugs can temporarily block the specific pathway that melanoma uses to grow. Because dabrafenib and trametinib block different parts of the same pathway, they can be more effective when taken together.
Patient must have BRAF gene mutation: For a patient to receive this type of targeted therapy, the melanoma tumor must have a specific mutation in the BRAF gene. A tumor biopsy, which involves removing some of the melanoma and testing it, can tell your doctor whether you have a BRAF gene mutation.
Patient responses to these drugs: These drugs can shrink melanoma tumors and slow the progression of melanoma. In clinical trials, patients had the following response rates:
While these drugs can be effective, they tend to stop working in time. When the drug stops working, the melanoma can progress. At that time, other treatment options can be considered.
How to take these drugs: All of these drugs are pills.
Note: A medical oncologist usually prescribes the pills and monitors patients.
Since some of the side effects can occur in the skin, patients taking one of these drugs usually see a dermatologist for one year.
Patients taking vemurafenib: Patients taking this drug must protect their skin from the sun because vemurafenib causes the skin to become extremely sensitive to sunlight. Spending just 5 minutes outdoors in the sun can cause sunburn. Patients also burn when they are outdoors in the shade.
In 2014, the FDA approved two drugs that can be considered when other treatments fail or stop working. Both nivolumab (Opdivo®) and pembrolizumab (Keytruda®) are FDA approved for patients who have:
Because some patients experience serious side effects, the FDA approved these drugs only for patients who have tried other treatment first.
How nivolumab and pembrolizumab work: Like ipilimumab, these drugs enable the body’s immune system to attack the melanoma cells.
Other treatments for advanced melanoma are being studied in clinical trials. More therapies are expected to be approved by the FDA.
If you are interested in exploring treatment options, you should ask your doctor which treatment might be a good fit for you.
Researchers continue to study the drugs discussed in this article. You can learn more about these drugs and look for clinical trials (run to improve drugs) that are accepting patients with advanced melanoma by clicking on the following pages:
Fox MC, Lao CD, et al. “Management options for metastatic melanoma in the era of novel therapies: a primer for the practicing dermatologist: part I: Management of stage III disease.” J Am Acad Dermatol. 2013 Jan;68(1)1.e1-1.e8.
Fox MC, Lao CD, et al. “Management options for metastatic melanoma in the era of novel therapies: a primer for the practicing dermatologist: part II: Management of stage IV disease.” J Am Acad Dermatol. 2013 Jan;68(1):13.e1-13e12.
Hinrichs CS, Rosenberg SA. “Exploiting the curative potential of adoptive T-cell therapy for cancer.” Immunol Rev. 2014 Jan;257(1):56-71.
Hodi FS, Lee S, et al. “Ipilimumab plus sargramostim vs ipilimumab alone for treatment of metastatic melanoma: A randomized clinical trial.” JAMA. 2014 Nov 5; 312(17):1744-53.
Hodi FS, Corless CL, et. al. “Imatinib for melanomas harboring mutationally activated or amplified KIT arising on mucosal, acral, and chronically sun-damaged skin.” J Clin Oncol. 2013 Sep 10;31(26):3182-90.
Robert C, Long GV, et. al. “Nivolumab in previously untreated melanoma without BRAF mutation.” N Engl J Med. 2014 Nov 16. [Epub ahead of print.]
Thompson JF, Agarwala SS, et al. “Phase 2 Study of Intralesional PV-10 in Refractory Metastatic Melanoma.” Ann Surg Oncol. 2014 Oct 28. [Epub ahead of print]
U.S. Food and Drug Administration, “FDA approves Opdivo for advanced melanoma.” FDA news release issued December 22, 2014.
Van Voorhees AS, “From the editor: Dermatology is sitting at an interesting juncture.” Dermatology World. 2014; 24(5):2.
Wolchok JD, Kluger H, et al. “Nivolumab plus ipilimumab in advanced melanoma.” N Engl J Med 2013; 369:122-133. (Funded by Bristol-Myers Squibb and Ono Pharmaceutical; ClinicalTrials.gov number, NCT01024231.)