This information should not be used to self-diagnose, or be used in place of a qualified physician’s care.

• Patients with melanoma are treated by members of the BC Cancer Agency’s Skin Tumour Group.
• For healthcare professional information on treating this cancer, please see our Cancer Management Guidelines.
• Cancers of the skin are also known as cutaneous cancers or dermatological cancers.
• Melanoma is a type of skin cancer and is the most aggressive or dangerous of all skin cancers.
• For the more common skin cancers called Basal Cell Carcinoma and Squamous Cell Carcinoma, see Skin Cancer – Non-Melanoma.
• Other cancers that affect the skin include Skin Lymphoma and Kaposi’s Sarcoma.
• Skin keeps moisture inside the body and repairs and renews itself as millions of dead skin cells are lost each day. The skin is also the outermost limit of the immune system.
• The skin consists of two layers: the outer epidermis and the supporting dermis. The dermis is made up of connective tissue, blood vessels, and nerves. Together the epidermis and the dermis contain hair follicles, sweat glands, sebaceous glands and nerve endings.
• New skin cells are produced in the bottom layer of the epidermis called the basal layer, just above the dermis.
• The epidermis also contains melanocytes, the cells which produce melanin, the pigment responsible for skin colour.
• Cutaneous (skin) malignant melanoma originates in the melanocytes which are the cells in the epidermis which produce melanin, the pigment responsible for skin colour. Moles, or nevi, are not usually cancers.
• Melanocytes also exist in the eye. For ocular melanoma, see Eye or Orbital cancers.
• Melanoma of the skin may start in an existing mole (nevus) or in a new area.
• It is extremely important that this type of cancer be detected in its earliest stages. The growth rate is variable but may be rapid and melanoma is highly invasive.
• Melanomas can recur at the primary site if incompletely removed.
• Melanoma may spread (metastasize) by way of the lymph system or the blood stream.
• If regional lymph nodes are free of tumour, recurrence is much less likely than if they are involved.
• The most common sites for metastases are the lymph nodes, skin, lungs, brain, spinal cord, and liver; although they can spread anywhere in the body.
• Superficial melanomas can be cured, but tumours that spread through the skin into the fatty tissue underneath are less able to be curable.

What causes it and who gets it?
Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

• Too much exposure to ultraviolet (UV) light, which is a type of radiation, causes damage to the skin. Damage includes sunburn, wrinkles, and aging. Tanning is a response of the skin to injury.
• Exposure to sunshine increases the risk of skin damage, particularly repeated or intermittent episodes of intense sun exposure in childhood.
• UV light from sun tanning beds also causes skin damage.
• Melanomas are most common in light-skinned people with freckles and many moles.
• Melanoma is most common in people in their forties to sixties and is rare in children.
• In white women melanomas occur most often on the back and legs; in white men on the back and trunk.
• A person who has developed one melanoma has an increased chance of developing more. Patients who have been successfully treated must be monitored carefully.
• Most melanomas are secondary to sun damage, but they can appear in unusual locations such as the nailbed of a finger, toe, nose or on the mucus lining the inside of the mouth, vagina, or anus.
• Some moles called dysplastic nevi (atypical nevi) are more likely to become melanomas than others. Dysplastic nevi often appear larger than normal moles (more than 5 mm across), often with irregularity of edge and variable colour. Even though large in diameter, they are often quite flat. 
• Individuals who have a strong family history of melanoma (two or more first degree relatives with the disease) may carry a particular genetic mutation and have “atypical nevus syndrome,” also called “dysplastic nevus syndrome.”
• Statistics
• Melanoma is not as frequent as basal cell or squamous carcinoma (approximately 1 in 100 Canadians will get a melanoma).
•  The incidence of melanoma has been increasing in recent years, and mortality rates have increased in many countries.
• B.C.
• Canada 

Can I help to prevent it?

• Protect your skin from the sun and other sources of ultraviolet (UV) light.
• Avoid sunburn, particularly in children.
• Avoid tanning beds, salons and sunlamps
• Limit time in the sun, especially between 11am and 3 pm.
• Seek shade.
• Cover up by wearing long sleeves and pants and a hat with a wide brim.
• Use sunscreen, specifically one labeled broad-spectrum, SPF 30. 
• Be aware that some drugs increase your reaction to ultraviolet radiation. Check with your doctor or pharmacist if you are taking prescription drugs.

Sun Safety

• The BC Cancer Agency’s Prevention Programs offer specific advice on preventing skin cancers for people of all ages.
• For detailed prevention tips and ideas for children, teens, adults, outdoor workers, sunbathers, outdoor sportspeople, users of tanning beds, see these websites:
• Sun Safety
• SunTips 
• Hi5Living
• Pre-School Sun Awareness
• Sun Safety brochures 

Sunscreens

• Sunscreens are not intended to increase your exposure time but to increase your protection during unavoidable sun exposure.
• Everyone, even if not in a high risk category, should avoid repeated extensive exposure to sun, wear protective clothing and use sunscreens with at least SPF 30.
• A list of sunscreens currently recognized by the Canadian Dermatology Association is available.
• Sunscreen ingredients are effective for at least two years (check expiration date on package). There is no evidence that the active ingredients in sunscreens cause cancer in humans.
• For a complete physical block, opaque sunblocks such as zinc oxide or titanium dioxide should be used if extreme sun exposure is likely (e.g., skiers, mountain climbers).
• Protect the lips with lip sunscreen or zinc oxide.
• Do not apply oils to the skin. They usually increase the likelihood of a sunburn.

Sun Tanning Beds

• Beginning in fall 2012, B.C. will ban commercial tanning bed use by young people under the age of 18 to reduce the chances of developing skin cancer later in life.
• The use of sun tanning beds and sunlamps is strongly discouraged because they give off UV radiation that cause skin damage.
• The suntan provided by sunbeds/tanning booths is only minimally protective against a sunburn.  If you do go to a tanning salon, continue to use a good sunscreen even after acquiring the artificial tan.  A tan does not completely protect you from harmful radiation. 

Screening for this cancer

• Any nevus or mole that has significant changes in shape or colour, or a mole that causes symptoms of itching or burning, should be suspected to be a melanoma.
• The acronyms ABCD or ABCDE refer to features that are used to identify those moles and skin lesions that require a biopsy to rule out melanoma:
• Asymmetry
• One half doesn't match the other half.
• Border irregularity
• Edges are ragged, notched, or blurred.
• Colour variation
• The pigmentation is not uniform, i.e. tan, brown, black can be present together.
•  A special concern is the mixing of shades of red, white and blue.
• Diameter greater than 6 millimeters (larger than a pencil eraser) is cause for special attention. 
• Particularly in a very flat mole
• Sudden increase in size is of special concern
• Darkening of an existing mole
• Slow change is much more common
• Evolution, or changes in mole surface, shape, feel, or surrounding skin
• Watch for scaliness, flaking, oozing erosion (as when a scab comes off), bleeding
• Appearance of a nodule or bulging, mushrooming mass
• Changes in how a mole feels to the touch
• Getting hard or lumpy
• Change in shape or outline of a mole
• Finding an irregular, notched border where it used to be regular and smooth
• Sudden elevation of a surface that used to be flat
• Change in skin around a mole
• Spread of pigment from the edge of the mole into the skin that used to be normal lookin
• Finding redness or swelling (inflammation)
• A very late sign is the development of satellite pigmentation (that is, nodules of colour next to, but not a direct part of a mole)
• Onset of new feelings or symptoms in a mole, if it becomes itchy, tender, or painful

Diagnosis