Melanoma is an aggressive form of skin cancer with a predicted 8430 deaths in 2025. Melanoma arises from the pigment producing cells in the skin, known as melanocytes. When these melanocytes go haywire and start to grow uncontrollably, that’s when you get melanoma.
Sometimes it’s assumed that you only have melanocytes where you see a mole on your skin. However, you have melanocytes everywhere you have skin, including mucosal skin. When they gather and grow, that is when you can see a visible mole like Cindy Crawford’s classic beauty mark. What you might not know is that melanoma more commonly arises from normal appearing skin and not an existing mole. While it’s important to monitor your moles for changes, about 70% of melanomas arise de novo or from a completely new lesion. That’s also why it’s important to use sunscreen everywhere and not just where you see a mole. No matter where you have skin, it is possible for a melanoma to pop up. Now you know that sun protection is a constant theme to prevent melanoma. However, you can still develop melanoma even if you don’t have sun damage. Around 30% of melanomas are not related to the sun or other UV exposure. Melanomas that are typically not related to UV exposure include melanoma in the eyes, mouth, genital region, palms, soles and nails. Pediatric melanoma is another example where UV exposure isn’t the primary cause. If you think about it, children typically haven’t had enough time to get the UV exposure that contributes to melanoma formation. While we don’t fully understand the underlying cause of these melanomas, it’s likely that genetics plays a prominent role as well as other triggers to cause mutations in melanocytes.
When you check your skin, you might follow the famous ABCDE rule to look at your moles. Perhaps the most important feature is C, which stands for color. Moles that change in color or show more than one color, with various shades of brown, black, gray, blue or white can be concerning. Nonetheless, some melanomas lack pigment and look more like a pink or colorless lesion. This type of melanoma is known as amelanotic melanoma and accounts for 5% of all melanomas. It is often overlooked but sometimes biopsied because it looks like a basal cell carcinoma or another suspicious lesion.
One interesting finding with melanoma is that it can go away on its own, a phenomenon we call regression. Now this doesn’t mean that we don’t treat melanoma and wait for it to resolve by itself. Melanomas need to be treated and early treatment results in better outcomes. Regression occurs when your immune system attacks a melanoma and has helped us develop immunotherapy to treat advanced cases. Unfortunately, regression of an entire melanoma often happens after it has spread to other parts of the body, such as the liver, lungs, bone or brain. Regression can be seen within a melanoma lesion on the skin and under the microscope as a histopathological finding.
When you think of who gets melanoma, you might think of someone who is older with light skin. However, anyone can get melanoma regardless of skin type, race, gender, or age. Young people are also impacted. Melanoma is the second most common type of cancer diagnosed in 15-to-19-year-olds, and the most common form of cancer affecting young adults between the ages of 25 and 29. In darker skin types, melanoma is more common on the palms, soles and the nails. Bob Marley, the famous reggae singer, died of a melanoma that was located on his foot. Even though melanoma is less common in darker skin, it is often diagnosed at a much later stage and has significantly lower survival rates as compared to non-Hispanic whites. This illustrates the delay in diagnosis and disparities in the healthcare system.
Trotter’s Take: Melanoma can affect anyone and may not fit the mold of a classic dark mole. Remember to check your skin and alert your dermatologist for any suspicious or changing lesions. One thing you might not know about melanoma is how it affects the caregiver. For a personal take on how a loved one with melanoma can affect you, check out my podcast with Leah Adams, a melanoma survivor herself and a caregiver for her father with metastatic melanoma.
