If you or a loved one has been diagnosed with melanoma skin cancer, you probably have dozens of questions. Getting a good grasp on the basics of melanoma can help you feel more prepared for what’s next. But with so much information to learn, it’s hard to know where to start.

In this article, we’ll discuss nine key facts about melanoma and what you need to know about early and advanced disease. If you have specific questions about your case of melanoma, be sure to talk to your doctor or oncologist (cancer specialist).

1. Melanoma Is the Fifth Most Common Cancer in the United States

Melanoma is the fifth most common cancer in American adults. It accounts for 5 percent of all new cancer cases in the United States. Overall, just under 98,000 people were expected to be diagnosed with melanoma in 2023.

Melanoma tends to affect older adults — the median age at diagnosis is 66 years. This means that half of people diagnosed with melanoma are younger than 66, and half are older.

2. People With Fair Skin Are More Likely To Develop Melanoma

Melanoma develops in melanocytes, the skin cells that make the pigment melanin. This pigment gives your skin its natural color. People with fairer skin make less melanin, while those with darker skin make more.

Melanin protects your skin cells from the sun’s damaging ultraviolet (UV) rays. If you have lighter skin, you’re more likely to develop melanoma. This is because your melanocytes are at a greater risk of being damaged by UV radiation. Melanoma is 20 times more common in white people than it is in Black people.

Overall, white people have a 1 in 33 chance of developing melanoma. In contrast, Hispanic people have a 1 in 200 chance, and Black people have a 1 in 1,000 chance.

3. Melanoma Stages Are Based on Tumor Details

Melanoma stages are based on:

• How thick your tumor is or how deep it has grown into the skin
• Whether the cancer has spread to any lymph nodes and, if so, how many are affected
• Whether the cancer has spread to distant parts of the body

Early-stage melanomas are typically defined as stage 0 (melanoma in situ), 1, or 2. In these stages, the melanoma hasn’t spread to any lymph nodes or other areas of the body.

Advanced melanoma refers to stage 3 melanoma that can’t be treated with surgery and stage 4 melanoma. In stage 3 disease, the melanoma cells have spread away from the main tumor and into the lymph nodes. Some people have nearby satellite tumors. A satellite tumor is a new tumor that has grown near the original melanoma tumor but is separate from it.

Stage 4 or metastatic melanoma has spread to other parts of the body. The main tumor can be any size and thickness and may or may not have spread to the lymph nodes.

4. Outlook Changes With Your Melanoma Stage

The prognosis (outlook) of cancer is usually discussed in terms of the survival rate. This refers to the number of people with a certain type and stage of cancer who are still alive after a certain period.

The National Cancer Institute provides the relative five-year survival rate for melanoma. It gives the likelihood of a person with melanoma living for five years when compared to the general population. This survival rate can’t predict your exact prognosis, but it can give you a better idea of the outlook for others with your melanoma stage.

When averaging all melanoma stages, the American Cancer Society reports a relative five-year survival rate of 94 percent. This means that people with melanoma are 94 percent as likely to live after five years compared to the general population.

As melanoma stages advance, the relative five-year survival rate decreases:

• Localized disease (stages 1 and 2) — Greater than 99 percent survival rate, with cancer only in the spot where it first appeared and hasn’t spread
• Regional disease (stage 3) — 74 percent survival rate, with cancer having moved to nearby lymph nodes or tissues but still close to where it started
• Distant disease (stage 4) — 35 percent survival rate, with cancer having spread to parts of the body far away from where it originally started

5. New or Changing Moles May Be Early Signs of Melanoma

For most people, the first sign of melanoma is a new or changing mole on the skin. Moles are usually tan or brown and smaller than a pencil eraser (6 millimeters).

Be sure to let your doctor or dermatologist (skin specialist) know if you’ve noticed any signs described by this acronym: ABCDE. When it comes to melanoma signs, the first five letters of the alphabet stand for:

• Asymmetry — One side of the mole is a different shape from the other.
• Border — The edges of the mole are uneven, blurred, or ragged.
• Color — The mole has several colors, which can include brown, black, tan, gray, pink, white, red, or blue.
• Diameter — The mole is larger than 6 millimeters across.
• Evolving — The mole has changed in color, size, texture, or shape.

6. Advanced Melanoma May Cause Body-Wide Symptoms

As melanoma spreads, it begins affecting other parts of the body. Stage 3 melanoma that has grown into the lymph nodes can cause swelling and lead to lumps under the skin. Stage 4 melanoma is associated with body-wide symptoms, including:

• Fatigue
• Loss of appetite
• Weight loss
• Headaches

You may also experience side effects depending on where in your body the melanoma has spread. For example, metastatic melanoma in the lungs can cause chest pain, coughing, fluid buildup around the lungs, and shortness of breath.

7. Doctors Diagnose Melanoma With a Skin Biopsy

The only way to confirm a melanoma diagnosis is with a skin biopsy. Depending on the size and location of your tumor, your doctor will likely perform a wide excision. This procedure removes the entire melanoma tumor along with a border of healthy skin. They’ll send the sample to a lab, where a specialist (pathologist) will process the sample and look at it under a microscope.

You may also have a lymph node biopsy to check if any cancer cells have spread into nearby lymph nodes. If you have advanced cancer, your doctor will remove these lymph nodes to stop your cancer from spreading any further.

8. Surgery Can Cure Early-Stage Melanoma

In most cases, early melanoma can be completely removed with surgery, curing you of the disease. Your doctor will continue monitoring you over time to make sure your cancer doesn’t return. Continued monitoring is essential if you had a thicker tumor.

If you have stage 2 melanoma and are at a high risk of it returning, your doctor may prescribe an adjuvant treatment. This additional treatment helps destroy any cancer cells left behind after surgery. One option is an immune checkpoint inhibitor (ICI), which activates your immune system to fight cancer.

9. Treatment for Advanced Melanoma May Include Immunotherapy and Targeted Therapy

Sometimes, surgery doesn’t work for advanced melanoma. Doctors often choose to prescribe body-wide or systemic treatments to target tumor cells throughout the body. Depending on specific details about your cancer cells, immunotherapy or targeted therapy may be recommended.

Examples of immunotherapy include ICIs like nivolumab (Opdivo), ipilimumab (Yervoy), and nivolumab and relatimab (Opdualag). Advanced melanoma that can’t be removed with surgery can also be treated with talimogene laherparepvec (Imlygic) or T-VEC. This viral treatment is injected directly into tumors, destroying cancer cells.

In about half of all melanomas, cancer cells have mutations (changes) in the BRAF gene. Doctors can target this mutation with BRAF inhibitors like vemurafenib (Zelboraf) or dabrafenib (Tafinlar) to slow tumor cell growth. BRAF inhibitors are usually combined with other medications known as MEK inhibitors to be more effective. Examples of MEK inhibitors include trametinib (Mekinist) and cobimetinib (Cotellic).

Chemotherapy and radiation therapy aren’t as commonly used in advanced melanoma. They can help in certain situations — such as if your cancer stops responding to other treatments.

The Bottom Line

In its beginning stages, melanoma usually stays on the skin’s surface, which makes it much easier for doctors to remove it entirely through surgery. Early detection is crucial because it prevents the cancer from getting into deeper layers of the skin or spreading to other parts of the body. Make sure to watch your skin for any changes and consult your doctor if you notice anything unusual. Identifying and treating melanoma at an early stage improves the likelihood of a positive outcome. It’s all about being aware and taking action early.

Talk With Others Who Understand

MyMelanomaTeam is the social network for people with melanoma and their loved ones. On MyMelanomaTeam, members come together to ask questions, give advice, and share their stories with others who understand life with melanoma.

Are you or a loved one currently living with melanoma? Share your experience in the comments below, or start a conversation by posting on your Activities page.