Melanoma is the most aggressive form of skin cancer and occurs when melanocyte cells mutate and begin to multiply uncontrollably. The main causes of melanoma include excessive exposure to ultraviolet (UV) radiation from the sun or tanning beds, which can damage the DNA of skin cells and promote the appearance of mutations. Genetic factors also play an important role, and people with a family history of melanoma have a higher risk of developing this condition. Other factors that may contribute include fair skin, immunosuppression caused by diseases or medical treatments, exposure to toxic substances and advanced age, with melanoma being more common in men over 50.
Melanoma symptoms vary, but the most common sign is a change in the appearance of an existing mole or the appearance of a new pigmented lesion on the skin. A mole that changes in size, shape, or color, has irregular edges, multiple shades of color, or starts to itch and bleed may be a sign of melanoma. Melanoma can also appear in areas less exposed to the sun, such as the palms of your hands, soles of your feet, or under your nails, making early diagnosis essential for effective treatment.
What is melanoma and why is it so dangerous?
Melanoma is a type of skin cancer that develops from melanocytes, the cells responsible for producing melanin, the pigment that colors the skin. This condition is considered the most aggressive form of skin cancer because it has a high ability to spread quickly to other organs, such as the lungs, liver, or brain.
How does melanoma progress over time?
Melanoma has a progressive evolution and goes through several stages, from the early stages, when it is limited to the superficial layer of the skin, to advanced forms, in which the cancer spreads to other parts of the body. The evolution of the disease depends on the time of diagnosis, the depth of the tumor and its ability to invade surrounding tissues or metastasize.
Early melanoma
In the initial stages, melanoma develops on the surface of the skin and can be identified by the change in an existing mole or the appearance of a new pigmented lesion. At this stage, the cancer is limited to the epidermis or superficial dermis, and complete surgical removal can lead to a cure in over 90% of cases. However, if not diagnosed in time, melanoma can penetrate deeper into the skin and begin to spread.
Stages of Melanoma
Stage 0 (melanoma in situ) – Cancer cells are located only in the superficial layer of the skin (epidermis) and have not invaded adjacent tissues.
Stage I – The tumor is thin (less than 2 mm thick) and shows no signs of spreading. The chances of cure are very high if it is surgically removed.
Stage II – The tumor is thicker than 2 mm and may have ulceration, which indicates an increased risk of spreading. Surgical treatment is essential, and sometimes additional therapies are recommended to prevent recurrence.
Stage III – Cancer cells have spread to nearby lymph nodes or to the skin around the primary tumor. At this stage, treatment involves surgery, targeted therapy, immunotherapy, or radiation therapy.
Stage IV – Melanoma has spread to distant organs, such as the lungs, liver, or brain. Treatment is complex and includes immunotherapy, targeted therapies, chemotherapy and radiotherapy, but the prognosis becomes reserved.
Types of melanoma and clinical manifestations
Melanoma can occur in different forms, each with specific characteristics in terms of clinical appearance, speed of evolution and location on the body. Identifying the type of melanoma is essential for establishing an appropriate treatment plan and for estimating the prognosis of the disease.
Superficial melanoma
Superficial extension melanoma is the most common type of melanoma, representing approximately 70% of cases. It develops slowly and remains in the superficial layer of the skin for a long time before penetrating deeper. It manifests itself in the form of a pigmented spot with irregular edges and varied colors (brown, black, red, white or blue). It appears most frequently on the trunk in men and on the lower limbs in women, and the prognosis is favorable if detected early.
Nodular melanoma
Nodular melanoma is an aggressive form, characterized by rapid and invasive growth. It appears as a dark nodule (black, brown, blue) or, in some cases, pink or reddish. It grows deeper faster than other types of melanoma, with an increased risk of metastasis. It is the second most common type of melanoma and usually appears on the trunk, head or neck.
Lentiginous melanoma
Lentiginous melanoma develops mainly in older people, on areas exposed to the sun for a long time, such as the face, neck or hands. The evolution is slow, and the lesion appears as a flat pigmented spot, with irregular edges and an uneven color. It is less aggressive than nodular melanoma, but can become invasive if left untreated.
Acral lentiginous melanoma (in the palms or soles)
This rare type of melanoma usually affects the palms, soles and nail beds. It is more common in people with darker skin and may go unnoticed due to its atypical location. It appears as an irregular pigmented spot or a dark line under the nail (subungual melanoma). Because it is often diagnosed late, it has a less favorable prognosis.
Ocular and subungual melanoma
Ocular melanoma is a rare form of melanoma that affects the choroid, iris, or conjunctiva. It manifests itself as vision problems, pigmented spots on the iris, or an abnormal growth of a blood vessel in the eye. Because it is not visible on the skin, diagnosis is often delayed, requiring ophthalmological investigations for detection.
Subungual melanoma appears as a pigmented line under the nail, which can be confused with a bruise. Unlike benign lesions, it does not disappear over time and can lead to nail deformity. It is most commonly found on the big toe or toe and requires a biopsy to confirm the diagnosis.
Causes and risk factors for melanoma
Melanoma occurs when skin cells mutate and multiply uncontrollably, forming malignant tumors. Although the main cause is excessive exposure to ultraviolet radiation, there are other factors that can influence the risk of developing the disease.
Ultraviolet radiation (main cause)
Prolonged and repeated exposure to UV radiation, either from the sun or from tanning beds, is the main risk factor for melanoma. UV radiation can damage cellular DNA, favoring mutations that lead to the development of skin cancer. Frequent sunburns, especially in childhood, significantly increase the risk of melanoma in adulthood.
Family history and genetics
People with first-degree relatives diagnosed with melanoma have a higher risk of developing the disease, which suggests an important genetic component. Certain inherited genetic mutations may predispose to the development of melanoma, and genetic testing can help identify these risks.
Immune system and other associated conditions
A weakened immune system, whether due to autoimmune diseases, HIV infection, or immunosuppressive treatments (such as those administered after an organ transplant), can increase the risk of melanoma. Also, the presence of conditions such as xeroderma pigmentosum, which affects the skin's ability to repair UV damage, can favor the development of this type of cancer.
We are waiting for a complete evaluation of your immune system!
Signs and symptoms of melanoma – How do you recognize a malignant mole?
Early identification of melanoma is essential for effective treatment. A suspicious mole or a new skin lesion should be examined by a dermatologist, especially if it changes in size, shape, or color.
The “ABCDE” formula for detecting dangerous moles
The “ABCDE” method helps identify potentially malignant moles:
A (Asymmetry) – One half of the mole does not look like the other.
B (Irregular Borders) – The edges are uneven, jagged, or diffuse.
C (Variable Color) – Several shades appear (brown, black, red, white, blue).
D (Diameter over 6 mm) – Large moles have a higher risk of being malignant.
E (Evolution) – Any rapid change in appearance, bleeding, or itching requires medical evaluation.
Suspicious Moles and Early Skin Lesions
Not all melanomas arise from pre-existing moles; some may begin as new spots on the skin. A lesion that grows progressively, changes color or causes unusual symptoms (itching, pain, bleeding) should be analyzed by a specialist.
Nodular melanoma and aggressive forms
Nodular melanoma is a rapidly invasive form that does not always follow the "ABCDE" rule. It appears as a pigmented (or even unpigmented) nodule, with rapid growth and a tendency to bleed. Due to its aggressive evolution, it is important that any suspicious lesion be evaluated urgently.
Diagnosis and staging in melanoma
To confirm the diagnosis of melanoma and establish the stage of the disease, several investigations are necessary, which help guide treatment.
Excisional biopsy and histopathological examination
The definitive diagnosis is made by excisional biopsy, which involves the complete removal of the suspicious lesion and its analysis under a microscope. The histopathological examination determines the type of melanoma, tumor thickness (Breslow index) and the presence of ulceration, essential factors for staging.
Sentinel node evaluation
If the melanoma is thicker than 1 mm, a sentinel node biopsy is recommended, which identifies the first lymph nodes to which cancer cells may have spread. A positive result indicates the presence of metastases and the need for additional treatment.
Imaging tests (CT, PET-CT) and blood tests
In advanced cases, imaging tests such as CT or PET-CT are performed to check whether the melanoma has spread to other organs. Blood tests, including lactate dehydrogenase (LDH) testing, can provide additional information about the prognosis.
Melanoma treatment
The therapeutic approach to melanoma depends on the stage of the disease, the location of the tumor and the presence of metastases. In early stages, the main treatment is surgical excision, while advanced melanoma requires modern systemic therapies.
Surgical excision
Surgical removal of melanoma is the standard treatment in early stages. The procedure involves excising the tumor along with a margin of healthy tissue to prevent recurrence. In advanced cases, removal of affected lymph nodes may be necessary.
Systemic therapies (immunotherapy, biological therapies, monoclonal antibodies)
For advanced or metastatic melanoma, treatment includes:
Immunotherapy – Drugs that stimulate the immune system to recognize and destroy cancer cells (e.g., nivolumab, pembrolizumab).
Targeted therapy – Inhibitors of specific genetic mutations (e.g., vemurafenib, dabrafenib) for patients with the BRAF mutation.
Monoclonal antibodies – Drugs that block the signals that allow tumor cells to multiply uncontrollably.
Discover biological therapy services from Quantica720°
Radiotherapy – when is it necessary?
Radiotherapy is not a first-line treatment for melanoma, but it can be used in certain situations. It is recommended when the tumor cannot be removed surgically, in case of brain or bone metastases, or to reduce the risk of relapse after removal of affected lymph nodes. It also helps to improve symptoms in advanced stages of the disease.
Metastases in melanoma and possible complications
Advanced melanoma can metastasize to the lymph nodes, lungs, liver, brain and bones, affecting the normal functioning of these organs. Brain metastases can cause headaches, seizures or neurological disorders, and pulmonary metastases can cause breathing difficulties. In such cases, treatment includes systemic therapies and palliative measures to control symptoms.
Melanoma prevention and recommendations for a healthy lifestyle
Adopting healthy habits can reduce the risk of melanoma and improve the prognosis for people diagnosed.
Skin self-examination and regular medical check-ups
It is essential to check your skin regularly for suspicious moles or lesions. Dermatologists recommend monthly examinations and annual medical consultations, especially for people at high risk of melanoma.
Sun protection and avoiding excessive exposure
To prevent the harmful effects of UV radiation, it is recommended to use a daily sunscreen with SPF 30+ and avoid direct exposure to the sun during peak hours (10:00-16:00). Wearing UV-protective clothing and avoiding tanning salons are additional protective measures.
Balanced diet and immune support
A diet rich in antioxidants (fruits, vegetables, fatty fish, nuts) contributes to skin health and strengthens the immune system. Avoiding smoking and reducing alcohol consumption can help prevent cell damage and reduce the risk of cancer.
We look forward to discovering all oncological therapies from Quantica720°
Conclusion
Melanoma is an aggressive skin cancer, but early detection and prevention can save lives. Sun protection, avoiding excessive UV exposure and monitoring moles are essential. Treatment ranges from surgery in early stages to immunotherapy and targeted therapies in advanced forms. A healthy lifestyle and regular check-ups contribute to reducing the risk and improving the prognosis.
Bibliography
DANSHINA, S., MARKOV, A., & ACHMAD, H. (2020). Causes, symptoms, diagnosis and treatment of melanoma. International Journal of Pharmaceutical Research (09752366), 12(3).
Schadendorf, D., Fisher, D. E., Garbe, C., Gershenwald, J. E., Grob, J. J., Halpern, A., ... & Hauschild, A. (2015). Melanoma. Nature reviews Disease primers, 1(1), 1-20.
Online articles
https://www.mayoclinic.org/diseases-conditions/melanoma/symptoms-causes/syc-20374884 - Accessed 28.02.2025
https://my.clevelandclinic.org/health/diseases/14391-melanoma - Accessed 28.02.2025
https://www.cancer.org.au/cancer-information/types-of-cancer/melanoma - Accessed 28.02.2025
