Understanding Melanoma: A Brief Guide
Melanoma is a serious form of skin cancer that develops when pigment-producing cells (melanocytes) grow uncontrollably. These cells sit between the epidermis and dermis which is the upper layers of the skin. Australia has one of the highest melanoma rates globally, with a lifetime risk of around 1 in 17 people as of 2023.
What Causes Melanoma?
Key risk factors include:
UV Radiation Exposure: Especially from sunlight or tanning beds, with early-life exposure posing the highest risk.
Severe Sunburns: Particularly during childhood or adolescence.
Personal or Family History: A past melanoma or family history of skin cancer significantly increases risk.
Other Factors: These include fair skin, older age, numerous or atypical moles, genetic predispositions, and the use of immunosuppressive medications.
Stages of Melanoma
Melanoma is staged based on its depth (Breslow thickness) and potential to spread:
In-situ Melanoma (Stage 0): Confined to the outer layer of skin (epidermis), with minimal risk of spreading.
Early Melanoma (Stage I): Less than 0.8–1 mm thick, with low risk of metastasis.
Intermediate Melanoma (Stage II–III): Deeper than 1 mm, with increased risk of spreading to lymph nodes or nearby tissue.
Advanced Melanoma (Stage IV): Has spread to lymph nodes or other organs and requires more intensive management.
Treatment Approaches
In-situ and Early Melanoma: Typically managed with Wide Local Excision (WLE) which is a surgical procedure to remove the lesion and a margin of healthy skin. Routine imaging (e.g. CT or PET scans) is usually unnecessary.
Intermediate Melanoma: WLE is performed with wider margins. A Sentinel Lymph Node Biopsy (SLNB) may be recommended to assess microscopic spread. A positive result may warrant further imaging and referral to a specialist.
Advanced Melanoma: Managed by a multidisciplinary team at a tertiary hospital. Treatment may include immunotherapy, targeted therapies, or clinical trials, with significant advances in outcomes in recent years.
Follow-Up Care
Regular skin checks are essential to detect recurrence or new skin cancers early:
In-situ Melanoma: Skin checks every 6–12 months for 5 years, then annually.
Early to Intermediate Melanoma: Skin checks every 3 months for 2 years, then every 6 months for 3 years, followed by yearly reviews. These visits assess the original melanoma site, nearby lymph nodes, and the full skin surface, while reinforcing sun safety and prevention strategies.
Reducing Your Risk
To reduce the chance of developing another melanoma (with recurrence risk up to 8%):
Apply broad-spectrum sunscreen daily and wear protective clothing.
Avoid deliberate sun exposure, particularly during peak UV hours.
Maintain vitamin D levels using supplements if needed and avoid using sun exposure as a source. Always consult your GP for personalised advice.
Recognising Recurrence
Be alert to:
Pigment changes, new spots, or redness near the melanoma scar.
Enlarged or firm lymph nodes nearby.
Report these to your doctor and attend your scheduled skin checks without delay.
Support and Awareness
A melanoma diagnosis can be confronting. Emotional and psychological support is just as important as medical care. Speak to your doctor, GP, or a qualified mental health professional. In Western Australia, the Melanoma Institute WA (melanoma.org.au) and Cancer Council WA (cancerwa.asn.au) offer expert information, counselling, and support services.
Inform first-degree relatives, as they may have a higher genetic risk. For guidance on discussing your diagnosis with family, visit cancer.org.au.
Written by Dr Emily Alfonsi
MBBS, FRACGP, DRANZCOG
Medical Director, Shade Skin
Dr Emily is a skin cancer doctor with advanced training in diagnosis and treatment. She has personally detected and treated hundreds of skin cancers and is passionate about early intervention and patient education.
