Current Status In Melanoma

Article:

Tasdogan A, Sullivan RJ, Katalinic A, Lebbe C, Whitaker D, Puig S, van de Poll-Franse LV, Massi D, Schadendorf D. Cutaneous melanoma. Nat Rev Dis Primers. 2025 Apr 3;11(1):23.

Understanding Melanoma: A Patient's Guide

What is melanoma? 

Melanoma is skin cancer that develops from melanocytes—the cells that produce melanin, the pigment giving your skin its color. While most skin cancers stay in one place, melanoma is more serious because it can spread to other parts of your body. The good news: if caught early, melanoma is highly curable with surgery alone.

What causes it? 

The biggest risk factor is UV radiation from sunlight or tanning beds, which damages DNA in your skin cells. About 90% of melanomas are linked to UV exposure. Other risks include having fair skin, red or light hair, many moles (especially unusual-looking ones), a history of severe sunburns (particularly in childhood), and a family history of melanoma. Some rare genetic conditions also increase risk.

How do doctors find it? 

Watch for the ABCD warning signs: Asymmetry (one half doesn't match the other), Border irregularity, Color variation, Diameter larger than 6 mm (though melanomas can be smaller), and Evolving size, shape, or color. Doctors use dermoscopy (a special magnifying tool) to examine suspicious spots more closely, which increases diagnostic accuracy by about 25%. A biopsy—removing all or part of the lesion for microscopic examination—is required to confirm melanoma and measure its depth (Breslow thickness), the single most important factor for prognosis.

Staging: How serious is it? 

Melanoma is staged 0 through IV based on thickness, whether it's spread to lymph nodes, and whether it's reached distant organs. Stage 0 (in situ) stays in the top skin layer. Stages I–II are localized and usually curable with surgery. Stage III means it's in nearby lymph nodes or skin. Stage IV means it has spread to distant organs. The earlier the stage, the better the outcome—stage I has near 100% survival, while stage IV historically had poor outcomes, though new treatments have dramatically changed this.

How is melanoma treated? 

Surgery is the mainstay for early-stage melanoma, removing the tumor with a margin of healthy skin (wider margins for deeper melanomas). A sentinel lymph node biopsy may be done to check if cancer has spread microscopically.

For stage III or IV disease, powerful systemic therapies have revolutionized outcomes over the past decade:

- Immunotherapy (checkpoint inhibitors like pembrolizumab, nivolumab, or combinations) unleashes your immune system to attack melanoma cells. These can produce durable responses—some patients remain cancer-free for 5+ years.

- Targeted therapy (BRAF/MEK inhibitors like dabrafenib-trametinib) works in patients whose melanoma has a BRAF mutation (about 50%). These drugs work quickly but resistance can develop.

- TIL therapy (lifileucel)—harvesting and expanding your own tumor-fighting immune cells—is now approved for advanced melanoma after other treatments.

-  Neoadjuvant therapy (treatment before surgery) is increasingly used for resectable stage III melanoma and shows better outcomes than surgery followed by adjuvant therapy.

Prevention and follow-up 

After melanoma, lifelong skin surveillance is critical—25% of patients with multiple melanomas will develop another. Protect yourself: avoid midday sun, never use tanning beds, wear protective clothing and sunscreen (SPF 30+), and perform monthly self-exams. Annual total-body skin checks by a dermatologist are essential.

Take Home Message:

Melanoma caught early is highly curable. Advanced melanoma, once deadly, is now often manageable or even curable thanks to immunotherapy and targeted therapy. Early detection through self-exams and dermatologist visits, combined with sun protection, gives you the best chance for excellent outcomes.