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Malignant melanoma is the most serious form of skin cancer and the most prevalent cancer disease. It is usually because you have burned several times in the sun. Almost everyone who gets treatment early gets rid of the disease.

The disease is very rare before puberty and uncommon during adolescence. But healthy sun habits are important even when you’re a child to reduce the risk of getting malignant melanoma as you get older.

Symptoms of malignant melanoma

Malignant melanoma is most common on the chest, back and legs but can occur anywhere on the skin. The most common symptoms of malignant melanoma are a brand new brown-black spot or knot that has grown or changed appearance. It may also look like a birthmark or a liver patch that is starting to change.

These may be signs that a change is a malignant melanoma:

  • It is irregular in shape and uneven in the edge.
  • It is uneven in color: for example different shades of brown, black, red, pink, blue or white.
  • It is larger than five millimeters.

Marks that bleed can also be signs of the disease.

Common birthmarks, also called nevi, are usually evenly brown in color and there is almost always a regular border on the skin all around. Spring-like and hairy marks are rarely signs of cancer.

There are also other types of skin cancer. The most common form is basal cell cancer, followed by squamous cell cancer.

Different types of malignant melanoma

There are different types of malignant melanoma. It goes differently before they begin to grow into the skin and increase the risk of cancer spreading.

Extremely growing melanoma

Superficial melanoma, or superficially spreading melanoma, can take months to years before it begins to grow down the skin. It is the most common melanoma among people under 50 and the type that increases most.

Lentigo malignant melanoma

You can get Lentigo malignant melanoma if you have been in the sun a lot, even if you have not burned. The melanoma usually sits in a  sun-damaged area of ​​the face and grows into the skin. It is more common among people over 50 years of age.

The precursor to this type of malignant melanoma is called lentigo maligna. You can have that for several years. During that time, the change can spread to the skin, sometimes several centimeters.

Nodular melanoma

Nodular melanoma, or knot-shaped melanoma, grows early in the skin. Melanoma is more common in people over 50 years of age. It often sits on your head or neck.

Acral lentiginous melanoma

Acral lentiginous melanoma is an uncommon type of malignant melanoma that is not at all due to solar radiation. The melanoma can sit in the palm, on the foot, the sole of the foot or under the nails. It is easy to confuse the melanoma with, for example,  foot fungus, nail fungus or ulcer that does not heal.

When and where should I seek care?

If you think you may have malignant melanoma, contact a health center or skin clinic. You can contact many receptions by logging in.

Contact a health care center as soon as possible if you have a change such as bleeding, growing rapidly or growing at any height, regardless of the color of the change. You do not need to seek care elsewhere if it is closed. Wait until the health center opens.

Investigations

You can get dressed and put on a breeze. The doctor examines all the spots and changes on the skin. A skin microscope, a dermatoscopy, is used at skin clinics and many health centers.

It is important that you tell what you have noticed in the skin change.

The standardized course of care for malignant melanoma

You are offered an examination according to a  standardized course of care if the doctor suspects that you have malignant melanoma.

Standardized care processes are a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the surveys you may need to do.

The doctor writes a referral and tells you why you should be investigated, what it means and when you can be told if you have cancer or not.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you so that you do not miss any time.

The skin change is removed for analysis

The change is removed and analyzed by a microscope at the slightest suspicion of malignant melanoma. 

Investigations if you have malignant melanoma

The dermatologist needs to examine you more if the analysis of the skin change shows that you have malignant melanoma.

Examination of lymph nodes

The doctor recognizes the lymph nodes on the neck, in the armpits and groin.

Sometimes a swollen lymph node needs more examination. Then insert the needle into the lymph node and suck out some cells that can then be analyzed.

A lymph node called the doorman needs to be removed completely to see if the melanoma has grown deep into the skin.

The portal gland is the first lymph node that the cancer cells reach if the disease has spread. The surgeon removes the portal gland while you are re-operating for the melanoma. See more in the chapter on Treatment.

X-rays may be needed

You may need to be examined with PET camera and computer tomography in order for the doctor to rule out that the melanoma has spread in the body.

New medical assessment

You can get a new medical assessment if you have been diagnosed with malignant melanoma and feel uncertain if you are receiving the care and treatment that is best for you. You will then see another doctor, usually at another specialist clinic.

Ask your doctor if you want to know more about how to get a new medical assessment.

Treatment for malignant melanoma

A malignant melanoma must be operated on as there is otherwise a risk of the cancer spreading. Most people get rid of the disease after surgery. In almost two out of ten people, the disease spreads, usually to the lymph nodes that are closest to the operated site. Then you get more treatment for malignant melanoma.

Malignant melanoma is removed

Another surgery is common after the skin change is removed and the analysis of it shows that it was malignant melanoma. The second operation is called enlarged excision. Then the surgeon removes some more of the healthy tissue around the place where the melanoma sat, for safety.

The operation is usually performed with local anesthesia. You can go home the same day. The wound heals after about two weeks.

A major operation wound may need to be covered with transplanted skin from any other part of your body. Then the operation is done either with local anesthesia or with anesthesia. Most can go home the day after a transplant operation. The wound heals after about three to four weeks.

It is different when you can go back to your normal life, for example with work or study. Some need to be on sick leave, but most do not have to.

Occasionally you may get tingling or reduced sensation in or around the scar, but it usually goes over.

If the concierge gland is also to be operated

The doorman and melanoma are operated simultaneously if the doorman needs to be examined. First, the gatekeeper gland needs to be identified.

You get a syringe in the skin with a radioactive substance that shows in which group of lymph nodes the pancreas is located.

Then you get a syringe with a blue substance that colors the concierge gland itself. It removes the surgeon when you are operated on. The concierge gland is sent for analysis.

Stop smoking before surgery

If you smoke, the winnings are many to stop before an operation. The wounds heal faster, blood circulation and fitness improve so you recover faster.

The best thing is to quit smoking completely, but if it fails, it is good if you can refrain from smoking before the surgery and even the first weeks afterward.

Talk to your doctor if you need help and support to quit smoking.

Treatment if cancer comes back or has spread

You need surgery again and also get another treatment for malignant melanoma if cancer comes back or has spread. It is called relapse if cancer returns.

Surgery

You will need surgery again if you have a recurrence of the old scar or if you have skin metastases. Skin metastases mean that the melanoma has spread to the skin.

You will also be operated on if the analysis of the removed doorman gland shows that it contained cancer cells. Sometimes, all lymph nodes in the neck, armpit or groin need to be removed.

You may get swelling in an arm or leg, depending on which lymph nodes have been removed. It’s called lymphedema. There is help to get.

Immunotherapy and targeted treatments

In immunotherapy and targeted treatments, drugs are used that in various ways strengthen the immune system or attack specific cancer cells. The drugs can be used if cancer has spread or if there is a risk of you getting sick again.

You will receive the medicines as tablets or as drops in the blood. They may seem fast, but it can also take a while to produce results. Sometimes the cancer cells can become resistant and then you need to change your medication.

The treatment can last from a few months to several years.

There are other medicines that counteract the side effects if you need to.

Immunotherapy: Antibodies help the immune system

There are drugs with antibodies that boost the immune system to stop the cancer cells. There are two groups of drugs:

The group of CTLA-4 inhibitors includes drugs with active substance ipilimumab.

The group of PD1 inhibitors includes drugs with active substances nivolumab and pembrolizumab.

The side effects you may have been due to the immune system being so stimulated that it starts to attack healthy parts of the body. It is called autoimmune reactions. For example, you may experience joint pain or other symptoms similar to the flu. You may also have skin rashes, inflammations, feel tired or depressed, or become very sensitive to sunlight.

Targeting treatments: Subjects seek out and stop cancer cells

There are drugs that seek out cancer cells and stop them from dividing and becoming more. The drugs work on malignant melanomas that have a certain kind of gene change. There are two groups of drugs:

The group of BRAF inhibitors includes medicines with active substances vemurafenib or dabrafenib.

The group of MEK inhibitors includes drugs with active substances trametinib or kobimetinib.

Side effects can be, for example, that you get skin rash, hair loss, muscle aches, fever or that you become very sensitive to sunlight.

Chemotherapy

Cytostatic drugs are a form of cell inhibitory drug that you can get if the disease has spread to other parts of the body. There are several different cytostatic drugs.

The drugs can in various ways cause the cancer tumor to shrink and prevent the cancer cells from multiplying. Some of the medicines you get as tablets, others you get as a drop in the blood. Sometimes you can get a combination of different cytostatic drugs.

It is common to receive treatment several days a week for a few weeks or a month. Then you can have a break for one month before the next cure. Sometimes the treatment is combined with immunotherapy.

For example, treatment with cytostatic drugs can make you feel nauseous, infectious or have anemia. Most side effects can be prevented or alleviated.

Treatment when cancer cannot be removed

You are given the care that can slow down or relieve the symptoms of cancer cannot be eliminated. It is called palliative care and can do so that you can live a good life with the disease, sometimes for a long time.

Participate in studies

There is a lot of research going on and there are several studies testing new forms of treatment. You may be asked to participate in studies. Participation in studies is always voluntary.

After the treatment

For most people who have had malignant melanoma, there are no physical or practical barriers to living life as it was before the illness. Still, it is common for life to be different. You always have the experience of what you have been with.

It is common for it to feel painful periodically, but usually, it gets better – although it may take time. Some feel vulnerable and worried long after treatment is over.

Do I need to go after checking?

Post-checks are sometimes needed to see that cancer has not returned. It varies from person to person how many post-checks are needed and how often you need to go. The risk of relapse decreases with time.

It is different in which examinations are needed for a post-check. For example, the doctor can examine the scar and other skin and feel the lymph nodes. Sometimes other examinations may be needed, such as cell samples or different types of X-ray examinations.

You do not need to go on post-check if the melanoma was detected at an early stage.

It is always important that you check your own skin regularly and seek care if you get suspicious changes again.

What is the cause of malignant melanoma?

Malignant melanoma is cancer in the skin cells that make the pigment melanin. Melanin protects us from the sun’s ultraviolet radiation, UV radiation.

The most common cause of malignant melanoma is that you have burned several times in the sun. The sun’s UV radiation damages the skin cells, even the pigment cells. The cells are mostly able to repair the damage. Cancer occurs when the repair does not work. Then the cell stops acting properly and can form cancerous tumors. Here you can read more about how cancer occurs.

Eye melanoma is cancer in the pigment cells that are present in the eye. It is an unusual disease that you do not really know the cause of.

How can I reduce the risk of malignant melanoma?

Sunbathing gently

Protect yourself from excessive UV radiation. 

Be vigilant about skin changes

Review your skin every now and then. You can use two tricks: The Ugly Duckling or the ABCDE Trick.

The ugly duckling – look for different birthmarks

Look for pigmented spots that somehow look different compared to most other spots and birthmarks.

It can also be a strain that grows unlike your other stains, or a brand new stain that you have received when you are over 40 years old.

A different spot is sometimes called an ugly duckling. The expression comes from a story by HC Andersen.

Be sure to be examined if you find a nasty duckling.

ABCDE trick

Asymmetry = irregularity. Melanoma often has an irregular shape.

Border = limit. Melanoma often has an unclear limit.

Color = color. Melanoma can have mixed colors: brown, black, blue, red, pink, white.

Diameter. Melanoma is often larger, with a diameter over five millimeters.

Evolution = development. Birthmarks or liver spots that change in some way can be melanoma.

Where should I look?

Examine the skin on the entire body:

  • The face, the head, behind the ears. Hairdryers can be helpful if you have hair on your head. Blow your hair aside to see the scalp.
  • The neck, trunk and under the breasts.
  • The arms, the armpits, the elbows, the hands, and the nails.
  • The neck, back, and buttocks. Ask for help or use a hand mirror.
  • The legs, the feet, under the feet and the nails.
  • In Life.

You may need to be extra careful

Take special care with the sun if one or more of the following points are true of you:

  • You have light skin and red or light hair. Then you have pigments that give the skin lower protection against the sun’s UV radiation.
  • You have many or large birthmarks. A  birthmark, or nevus, is large if it is over five millimeters in diameter.
  • Several people in your biological family have had malignant melanoma. The disease can sometimes be hereditary.
  • You are taking immunosuppressive drugs. Then the body has a reduced ability to care for sun-damaged skin cells. You will receive immunosuppressive drugs if, for example, you have had an organ transplant.
  • You have had malignant melanoma in the past.

You may be given regular check-ups if several biological relatives have had malignant melanoma.

You have a good chance of getting rid of the disease if it is detected early and you receive treatment.

Pigment spots and malignant melanoma if you are pregnant

Being pregnant does not increase the risk of malignant melanoma. It is unusual to be pregnant and get cancer. 

Usually with harmless pigment changes

The pigmentation in the skin can change when you are pregnant. This means that the skin around the nipples can darken, you can get pigmentation on the face and a dark stripe from the navel down. It is harmless and usually disappears after pregnancy.

You should be aware of other skin changes. Be sure to check if you notice a stain or knot that grows or changes in any other way. Read more in the chapter Symptoms and in the chapter When and where should I seek care?

If you are pregnant and have malignant melanoma

You can be examined and receive treatment even if you are pregnant. Sometimes care may need to be adapted in different ways. Computed tomography and PET cameras may need to be replaced by ultrasound or done to protect the fetus from radiation.

You can operate. You can receive cytostatic treatment after pregnancy in week 14.

Pregnancy does not affect the disease. Cancer cannot be transmitted to the fetus.

It is only if the cancer is growing rapidly or if it is early in pregnancy that the doctor sometimes recommends that you abort the pregnancy. It is you who decides.

You will be contacted by specialist maternal care.

Getting a cancer message

You can respond in many ways to a cancer message. It is common to need a lot of time to talk to your doctor and other healthcare professionals about what the message means.

If possible, please let a relative accompany you. The related person can act as a support and help to remember what has been said.

You can also ask to have the information written down so you can read it peacefully. Ask questions if you don’t understand. You also have the right to receive interpreting assistance if you have a hearing impairment.

In many hospitals, there are special nurses called contact nurses who should be especially accessible to the sick person and to their relatives. The contact nurse can provide support and also help with various practical things.

You can get support in several places

Talk to the contact nurse or the hospital’s curator if you feel anxious or have questions.

It is common for it to feel easier once treatment has begun and you know what is going to happen.

Children need to know

Children have the right to receive information and support based on their own needs if a relative is ill. You can get help with what you have to say if you want to and can tell the child yourself.

Often it is good to make children as involved as possible, regardless of age. But you may need to customize the information and not have to tell everything. It may be good to start with the child’s own questions. Here you can read more about talking to children when a parent is seriously ill.

Being related

It can feel difficult to be close to someone who is sick. It is common to want to support while you have a strong concern and feel bad.

If you have people close to you, they can be a support. Often it will be easier for them to help you if you tell them how it feels. You can also talk to the contact nurse if you are close and need supportive calls.

You can get relief if you help take care of or support the sick person. You can also get support, for example in the form of calls or help with practical things.

Muhammad Nadeem

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