Melanoma

The first symptom of melanoma skin cancer is usually a change in the shape, colour or size of a mole. It can be difficult to tell the difference between melanoma and a normal mole. We have more detail in our information about the signs and symptoms of melanoma.

If you have any signs of a change in a mole or develop a new mole, you usually begin by seeing your GP. Your GP will check your mole and ask about any family history of cancer. If they think you may have a melanoma, they will refer you to a doctor who specialises in skin conditions called a dermatologist.

You should be seen at the hospital within 2 weeks.

The dermatologist uses a dermatoscope. This looks like a small magnifying glass, to look at your mole. They also check the rest of your skin and will ask you about any other skin changes or if you have any other unusual moles. They may also check the lymph nodes (glands) closest to the mole. This is to see if they look or feel swollen.

If you have an unusual mole, your dermatologist may advise checking it regularly rather than removing it. These moles are sometimes called dysplastic naevi. Your dermatologist may ask you to come back in a few months to check if the mole has changed. Or they may arrange for you to come back regularly to have photographs taken of the unusual mole.

If you have symptoms of melanoma, your mole will need to be removed so the specialist doctor can find out what it is. This is called an excision biopsy.

Waiting for tests results can be a difficult time, we have more information that can help.

If tests show the mole is melanoma, your doctor may suggest tests to check the lymph nodes nearby.

Not everyone needs these tests. It depends on how deep the melanoma is and if the lymph nodes look or feel swollen. Lymph node tests include:

If the melanoma has spread to the lymph nodes, you may have the following tests to check if melanoma has spread anywhere else in the body:

Your doctor may arrange tests to look for certain gene changes (mutations) in the melanoma cells. The results of this type of testing tell your cancer doctor which targeted or immunotherapy drugs are likely to work for you if you should need them.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Most people will have surgery to remove more tissue from the area where the mole was removed. This is called a wide local excision. The aim is to remove all the cancer cells. For early melanoma this is often the only treatment you will need. Early melanoma means the cancer cells are only in the skin and have not spread from where the mole started.

If tests show the melanoma has spread to nearby lymph nodes, your doctor will talk to you about the best way of treating this.

You and your doctor may decide that having regular ultrasounds of your lymph nodes is the best option for you. These ultrasounds check if the cancer is growing in that area and if you need treatment.

Or your doctor may talk to you about having further treatment with targeted or immunotherapy drugs. This is called adjuvant treatment. It aims to reduce the risk of the melanoma coming back.

Sometimes your doctor may talk to you about having surgery to remove all the nearby lymph nodes. This may depend on the risk of the melanoma causing symptoms in that area.

Your doctor may offer you further treatment to reduce the risk of melanoma coming back after surgery. This is called adjuvant treatment. It is an option if there are factors that increases the risk the of melanoma coming back. It may be used for the following:

• Stage 2 melanoma – you may have a type of immunotherapy drug called pembrolizumab.
• Stage 3 melanoma – if tests show a BRAF gene mutation in the melanoma cells, you may have a combination of 2 targeted therapy drugs. These drugs are called dabrafenib and trametinib. If tests do not find a BRAF gene mutation, you may have one or, sometimes, a combination of immunotherapy drugs. These drugs are called Ipilimumab, pembrolizumab and nivolumab.

You usually have adjuvant treatment for up to 12 months. Your doctor and nurse will talk to you about the possible benefits and risks of having it. It is important to think about all these and how treatment and possible side effects may affect your daily life.

Sometimes your doctor may suggest not having treatment straightaway. They may do this if the risks of treatment outweigh the benefits. Instead your doctor may advise having regular appointments and tests.

Your specialist doctor or nurse will talk to you about the different treatment options and things to think about when making treatment decisions. You can then decide together what treatment is best for you. You may be offered some treatments as part of a clinical trial.

We have more information about treatment for melanoma.

Sometimes melanoma cannot be removed with surgery or tests show that the cancer cells have spread to other areas of the body. Your doctor and nurse will talk to you about the best way of managing this. If you need treatment this usually involves having targeted therapy or immunotherapy drugs. We have more in our information about advanced melanoma.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
• explain medical words
• use short sentences
• use illustrations to explain text
• structure the information clearly
• make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.