What is melanoma?

Melanoma is a cancer that begins in the melanocytes. Because most of these cells still make melanin, melanoma tumours are often brown or black. But this is not always the case, and melanomas can also have no colour.

Melanoma most often starts on the trunk of fair-skinned men and on the lower legs of fair-skinned women, but it can start in other places, too. Having dark skin lowers the risk of melanoma. But it does not mean that a person with dark skin will never get melanoma. Melanoma can almost always be cured in its early stages. But it is likely to spread to other parts of the body if it is not caught early. Melanoma is much less common than basal cell and squamous cell skin cancers, but it is far more serious.

What do levels and stages mean?

The ‘level’ of melanoma is the depth that the melanoma cells have grown into the skin. This is measured by the pathologist in millimetres, termed the Breslows Thickness. Alternatively there is the Clarkes Level, which is the anatomical layer in which the cells are seen.

The ‘stage’ gives some idea as to how far the melanoma has spread. Stage 1 and 2 are confined to skin, Stage 3 to lymph nodes, and Stage 4 to internal organs. There is often confusion between the Clarkes level on the pathology report and the stage. It is important to note that they are completely separate.

How is melanoma treated?

Surgery is the most common treatment. If it's done in the early stages, before the cancer has spread, there is a high chance that it can lead to a cure. During surgery, the doctor removes the cancer and normal cells around it. This is called an excision.

Chemotherapy, immunotherapy, or targeted therapy may also be used if it has spread to other parts of the body. Radiation might also be part of treatment, especially when a person can't have surgery.

After treatment, what is ongoing recommended follow up skin surveillance?

After removal of a melanoma, there are guidelines about the recommended follow up skin surveillance. Ask your Doctor for these guidelines.

What are clinical trials?

Clinical trials are carefully controlled research studies that are done with patients. These studies test whether a new treatment is safe and how well it works. Clinical trials may also test new ways to find or prevent a disease. These studies have led to many new ways to prevent, diagnose, and treat cancer.

Clinical trials are done to get a closer look at new treatments or procedures. A clinical trial is only done when there is good reason to believe that the treatment, test, or procedure being studied may be better than the one used now. Treatments used in clinical trials are often found to have real benefits. If that happens, they may go on to become tomorrow's standard treatment.

Prevention & Awareness

What are the risk factors of melanoma?

The following are risk factors associated with melanoma:

  • UV (ultraviolet) light
  • Moles
  • Fair skin
  • Red hair
  • Family history of melanoma
  • Past history of melanoma
  • History of sunburn
  • Weakened immune systems
  • Age
  • Gender

What can a I do to decrease my risk of getting melanoma cancer?

Most skin cancer can be prevented especially by preventative measures such as:

  • Be aware of UV levels and exposure
  • Slip on a shirt or sun protective clothing
  • Slip into the shade
  • Slop on sunscreen
  • Slap on a hat
  • Wrap on sunglasses
  • Check your skin regularly, and seek advice if there are any changes

Can I prevent melanoma?

There is no sure way to prevent melanoma. The best way to protect yourself from melanoma is to avoid getting a lot of sun. When going outside, everyone should use these tips to protect themselves.

  • Apply a broad-spectrum sunscreen of SPF (sun protection factor) 30 or higher. Coat yourself with sunscreen 15 minutes before going outside. Reapply at least once every 2 hours.
  • Seek shade when the sun is strongest and UV status is above 3. This is especially important if you live in an area of high sun intensity.
  • If you're going to be in the sun, wear long-sleeved shirts, long pants, and a wide-brimmed hat. Fabrics with a tight weave give the best sun protection. Special sun-protective clothing is now available as well.
  • Wear sunglasses with UV protection.
  • Know what the UV status is by downloading the free UV2day app (itunes and google play for android)

What are the signs?

The first sign is often a change in the size, shape or colour of an existing mole, or the appearance of a new mole. Find out more about early detection.

Where do I get a skin check?

What can I expect during a skin check?

Why is UV status important?

Most skin cancers are caused by exposure to UV radiation. The levels of UV radiation are from the sun changing angles. The sun protection alert tells you when you need to protect skin and eyes from the sun. It is affected by time of day, time of year, cloud cover altitude and reflection ie. off snow or water.

Are sunbeds safe?

No. The world Health Organisation advises that sunbeds and/or sunlamps should not be used unless under medical supervision. Sunbed use before the age of 35 is associated with a 59% increase in the risk of melanoma.

Sunscreen Facts

Sunscreen protects against/reduces the risk of melanoma, a potentially fatal skin cancer. Remember – a sunscreen is only part of your defence against harmful UV radiation. In addition limit your time in the sun and wear cover-up clothing. Be careful when buying sunscreen and check on the labeling to see whether they have been tested and meet Australian and NZ standards (testing is currently not mandatory in New Zealand). Consumer NZ often tests sunscreens and offers impartial advice on these.

How often should you be applying sun cream?

You should be applying a generous amount every two hours to maintain protection, particularly after sweating, swimming and direct contact with the sun. At the start of the day, apply thoroughly 15 to 20 minutes before you go outside so it’s fully absorbed into skin. And remember the neck, ears, feet, hands and scalp, as these bits often get forgotten.

And how much should you be using?

Roughly about one teaspoon or approximately 35ml per limb. Most bottles are only 200ml, which should last just a few days if applied and reapplied properly.

Is the SPF in your make-up enough for your face?

No – you should be using a minimum of SPF30 on your face, applied every two to three hours. Relying on getting this solely from make-up is unrealistic, particularly if make-up is not reapplied throughout the day, which is often the case. In addition seek shade, wear a hat and sunglasses

What does water resistant actually mean?

Water resistant sunscreens have a rating between 40 and 80, which indicates how long it remains effective whilst swimming or sweating – this means that after 40 or 80 minutes of swimming or sweating, sunscreen should be reapplied.

Do once-a-day sunscreens actually work?

Over the course of a day, sunscreen can easily be washed off or wiped away. This doesn’t mean that once-a-day sunscreens don’t work, but they should be reapplied every two to three hours and more often after being in the water and when doing physical activity.

What should you look out for on a bottle of sun cream?

SPF - SPF15 or lower won’t offer enough protection – use 30 as a minimum.

Water and Sweat Resistant - A water resistant sunscreen will adhere to the skin if you’re in and out of the pool, but bear in mind, all sunscreens need to be reapplied frequently.

Active Ingredients - Look for anything with the words: oxybenzone, avobenzone, octisalate, octocrylene, homosalate and octinoxate. These ingredients are designed to absorb or reflect rays. Some sunscreens do not include any of these substances, instead they’re packed with elements to ensure the sunscreen smells nice and feels luxurious, but it’s not protecting the skin.

Broad Spectrum - This guarantees the sunscreem is shielding you from UVA rays (which cause ageing and can penetrate clouds and windows) and UVB rays (which burn the skin and can cause cancer).

Expiry Dates - They matter. It’s great to be organised and purchase your sunscreen the year before, but it does have an expiry date and won’t work efficiently after it expires.

Creams vs Sprays - Sprays are designed to be quick and easy, allowing you to spray and go without getting your hands dirty, but they don’t always offer the best protection as it’s difficult to tell how much you’ve used. A cream is usually thoroughly rubbed into the body and you can squeeze out the desired amount.

Is there a big difference between SPF30 and 50?

An SPF 50 will block 98% of sunburn rays, whereas an SPF 25 will block 96%, so it’s not as straightforward as simply doubling the protection.

Any tips for those with sensitive skin?

Avoid perfumed products and those containing parabens. For prickly heat sufferers, it might not just be the temperature exacerbating your rash – if your SPF contains mineral oils it may well be worsening your condition.

What about those with acne?

Look out for sunscreens that don’t clog your pores and cause further irritation or blemishes.

Is it worth splurging on more expensive sun creams?

An SPF that costs a few dollars will be just as effective as a product with the same SPF that’s five times the price. If you’re splurging on sunscreen you’re not paying for a higher quality SPF but the other ingredients such as texture, fragrance or brand appeal.

Anything else?

It’s worth noting you should be wearing a lightweight SPF when you’re flying. When you’re on a plane, you’re around 30,000 miles closer to the sun, so think of the damage that can do, especially if you’re sat by a window.


Source acknowledgement:
Melanoma NZ information advisor, Sinda Hall and specialist/medical advisor, Dr Rosalie Stephens
University of Rochester - Health Encyclopedia
Cancer Schmancer Movement