The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:
From 2010 to 2019, the number of new cases of melanoma increased by about 1% per year, though the number of deaths each year from melanoma continues to decrease. Melanoma is most common in adults, but it is sometimes found in children and adolescents. For more information, see Childhood Melanoma Treatment.
There are two main forms of skin cancer: melanoma and nonmelanoma.
Melanoma is a rare form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips). This summary is about cutaneous (skin) melanoma and melanoma that affects the mucous membranes.
The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body. For more information, see Skin Cancer Treatment.
In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma forms most often on the arms and legs.
When melanoma occurs in the eye, it is called intraocular or ocular melanoma. For more information, see Intraocular (Uveal) Melanoma Treatment.
Anything that increases a person's chance of getting a disease is called a risk factor. Not every person with one or more of these risk factors will develop melanoma, and it will develop in some people who don't have any known risk factors. Talk with your doctor if you think you may be at risk.
Risk factors for melanoma include the following:
Being White or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.
For more information on risk factors for melanoma, see the following:
These and other signs and symptoms may be caused by melanoma or by other conditions. Check with your doctor if you have any of the following:
For pictures and descriptions of common moles and melanoma, see Common Moles, Dysplastic Nevi, and Risk of Melanoma.
In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures to find and diagnose melanoma:
There are four main types of skin biopsies. The type of biopsy done depends on where the abnormal area formed and the size of the area.
The prognosis and treatment options depend on the following:
The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
For melanoma that is not likely to spread to other parts of the body or recur, more tests may not be needed. For melanoma that is likely to spread to other parts of the body or recur, the following tests and procedures may be done after surgery to remove the melanoma:
The results of these tests are viewed together with the results of the tumor biopsy to find out the stage of the melanoma.
Cancer can spread through tissue, the lymph system, and the blood:
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if melanoma spreads to the lung, the cancer cells in the lung are actually melanoma cells. The disease is metastatic melanoma, not lung cancer.
To find out the stage of melanoma, the tumor is completely removed and nearby lymph nodes are checked for signs of cancer. The stage of the cancer is used to determine which treatment is best. Check with your doctor to find out which stage of cancer you have.
The stage of melanoma depends on the following:
In stage 0, abnormal melanocytes are found in the epidermis. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.
In stage I, cancer has formed. Stage I is divided into stages IA and IB.
Stage II is divided into stages IIA, IIB, and IIC.
Stage III is divided into stages IIIA, IIIB, IIIC, and IIID.
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In stage IV, the cancer has spread to other parts of the body, such as the lung, liver, brain, spinal cord, bone, soft tissue (including muscle), gastrointestinal (GI) tract, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first started.
The cancer may come back in the area where it first started or in other parts of the body, such as the lungs or liver.
Different types of treatment are available for patients with melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Surgery to remove the tumor is the primary treatment of all stages of melanoma. A wide local excision is used to remove the melanoma and some of the normal tissue around it. Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.
Sometimes, it is important to know whether cancer has spread to the lymph nodes. Lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the sentinel lymph node (the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor). It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, more lymph nodes will be removed and tissue samples will be checked for signs of cancer. This is called a lymphadenectomy. Sometimes, a sentinel lymph node is found in more than one group of nodes.
After the doctor removes all the melanoma that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Surgery to remove cancer that has spread to the lymph nodes, lung, gastrointestinal (GI) tract, bone, or brain may be done to improve the patient’s quality of life by controlling symptoms.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).
One type of regional chemotherapy is hyperthermic isolated limb perfusion. With this method, anticancer drugs go directly to the arm or leg the cancer is in. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drug is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
See Drugs Approved for Melanoma for more information.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy is used to treat melanoma and may also be used as palliative therapy to relieve symptoms and improve quality of life.
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.
The following types of immunotherapy are being used in the treatment of melanoma:
There are two types of immune checkpoint inhibitor therapy:
See Drugs Approved for Melanoma for more information.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. The following types of targeted therapy are used or being studied in the treatment of melanoma:
Combinations of BRAF inhibitors and MEK inhibitors used to treat melanoma include:
For patients with melanoma who are at high risk of the cancer coming back after it has been treated, there is a growing number of adjuvant therapy options which may be given to lower the risk. Adjuvant therapy may include immune checkpoint inhibitors and combinations of signal transduction inhibitors.
New targeted therapies and combinations of therapies are being studied in the treatment of melanoma.
See Drugs Approved for Melanoma for more information.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
Vaccine therapy is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it. Vaccine therapy is being studied in the treatment of stage III melanoma that can be removed by surgery.
For information about side effects caused by treatment for cancer, visit our Side Effects page.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage 0 is usually surgery to remove the area of abnormal cells and a small amount of normal tissue around it.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage I melanoma may include the following:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage II melanoma may include the following:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage III melanoma that can be removed by surgery may include the following:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma may include the following:
Treatments that are being studied in clinical trials for stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma include the following:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For more information from the National Cancer Institute about melanoma, see the following:
For general cancer information and other resources from the National Cancer Institute, visit:
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PDQ® Adult Treatment Editorial Board. PDQ Melanoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389388]
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