As a rule, if you notice anything unusual on your skin that doesn’t go away in a month, go to see your doctor about the spot or mark.
Perhaps take a photograph of any unusual spots that develop so you can see any changes over time. Keep in mind that there are many skin conditions that are not cancer, especially in older people.
Checking for signs of melanoma
Usually, the signs of melanoma are quite visible. That’s because they occur mostly on skin that’s exposed to the sun.
To help you spot melanoma early, it helps to be aware of how your skin normally looks, so you can recognise any changes more easily.
Get your partner or a close friend to check your back or other areas that you can’t easily see.
Where melanoma develop
Melanoma can develop on or near other non-cancerous (benign) skin growths. You should show your doctor any area of your skin that is damaged and does not heal up.
The symptoms of melanoma may be similar to symptoms of other skin conditions. It is worth having any symptom checked by your GP. Your doctor won’t think you are bothering them for something trivial. They can decide whether your symptoms need to be investigated further.
How melanoma appears
The signs of melanoma are best summarised by the ABCDE criteria They are:-
- Border irregular
- Colour irregular
- Diameter more than 6mm
- Elevation - becoming more raised
The most important sign is change over time of colour shape or size.
The stages of melanoma
The tests used to diagnose your melanoma will give some information about the stage, which describes how deep it has grown into the skin, and whether it has spread.
Staging helps consultants to decide on the kind of treatment you need, the risk of a melanoma returning and whether you need any tests to see if the melanoma has spread into any lymph nodes.
Most melanomas are discovered at an early stage when the chance of cure is high.
Types of melanoma staging systems10
Consultants use a few different systems and scales to describe the different stages of melanoma. The AJCC Staging System gives a stage of 0 to 4. Stage 0 means that the melanoma lies only in the epidermis, which is the upper layer of the skin. It has not become invasive and the likelihood of it returning is very small. The highest stage is 4, which means the melanoma has spread to other organs. In general the higher the stage, the poorer the prognosis.
However the simplest way of telling how likely it is to recur is by the Breslow thickness, which is measured by the pathologist after the biopsy.
The Breslow depth or thickness
This system measures the thickness of the melanoma in the skins using a small ruler called a micrometre. The measure that doctors use is called the primary tumour thickness scale, or the Breslow thickness, and it measures in millimetres (mm) how far the melanoma cells have reached down through the skin from the surface. The deeper the Breslow thickness, the more likely the melanoma is to return.
AJCC stages of melanoma
There are five main stages to the number system, and these are:
- Stage 0 (in situ melanoma): The melanoma cells are only in the top surface layer of skin cells (the epidermis) and have not spread into deeper layers.
- Stage 1A: The melanoma is less than 1mm thick, and the covering layer of skin over the tumour is not ulcerated or broken – it is only in the skin and has not spread elsewhere.
- Stage 1B: The melanoma is less than 1mm thick and the skin is broken (ulcerated), or it is between 1 and 2mm and is not ulcerated – it is only in the skin and has not spread elsewhere.
- Stage 2A: The melanoma is between 1 and 2 mm thick and is ulcerated, or it is between 2 and 4mm and is not ulcerated – it is only in the skin and has not spread elsewhere.
- Stage 2B: The melanoma is between 2 and 4mm thick and is ulcerated, or it is thicker than 4mm and is not ulcerated – it is only in the skin and has not spread elsewhere.
- Stage 2C: The melanoma is thicker than 4mm and is ulcerated, but it is only in the skin and there is no sign that it has spread to lymph nodes or other parts of the body.
- Stage 3A: The melanoma has spread to up to three lymph nodes near the primary tumour, but the nodes are not enlarged and cells can only be seen under a microscope. The melanoma is not ulcerated and has not spread to other areas of the body.
- Stage 3B: The melanoma is ulcerated and has spread to between one and three lymph nodes, but the nodes are not enlarged and the cells can only be seen under a microscope
the melanoma is not ulcerated and it has spread to between one and three lymph nodes nearby and the lymph nodes are enlarged
the melanoma is not ulcerated, and has spread to small areas of skin or lymphatic channels, but nearby lymph nodes do not contain melanoma cells.
There are melanoma cells in the lymph nodes and small areas of melanoma cells in the skin or lymph channels close to the main melanoma
the melanoma is ulcerated and has spread to between one and three lymph nodes nearby which are enlarged
the melanoma may or may not be ulcerated and has spread to four or more nearby lymph nodes
the melanoma may or may not be ulcerated and has spread to lymph nodes that have joined together.
- Stage 4: At this stage melanomas have spread elsewhere in the body, far away from where they started (the primary site) and the nearby lymph nodes. The most common places for melanoma to spread are the lung, liver or brain, or to distant lymph nodes or other areas of the skin.
It’s important to note that, in the UK, most melanomas are early stage 1 and surgery is usually very effective – this is also the case for stage 2 tumours.
10 Cancer Research UK, Stages of melanoma http://www.cancerresearchuk.org/about-cancer/type/melanoma/treatment/stages-of-melanoma